Younger Males May Face Higher Heart Attack Risk, 7 Years Before Females

New research indicates that men in their 30s may have a higher risk of heart attack compared to females. Image Credit: Thomas Barwick/Getty Images

• A recent study found that younger males develop a slight risk of cardiovascular disease seven years before females. 
• The risk of coronary heart disease began to diverge between males and females around age 35. 
• This earlier risk profile in males suggests that factors beyond high blood pressure and diabetes may be at play. 

Cardiovascular disease is an umbrella term for coronary artery disease, cerebrovascular disease, peripheral artery disease, and aortic atherosclerosis. Each of these conditions comprise other cardiovascular events like heart attack and stroke. 

A recent large, long-term study found that young males may develop coronary heart disease years earlier than females.

The findings, published on January 28 in the Journal of the American Heart Association (JAHA), show that sex-based differences in cardiovascular risk emerged among male participants during their mid-30s.

“These changes begin insidiously in the 30s and can remain symptomless,” said Timur Alptunear, MD, RN, who wasn’t involved in the study. “Along the continuum of cardiovascular disease, this earlier risk is a result of accumulation, not due to the emergence of disease,” he told Healthline.

According to this research, heart disease screening and prevention should begin earlier in adulthood, especially for males. The recommendation is based on more than three decades of follow-up research. 

“That timing may seem early, but heart disease develops over decades, with early markers detectable in young adulthood,” Alexa Freedman, PhD, assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine, and senior author of the study, said in a press release. 

“Screening at an earlier age can help identify risk factors sooner, enabling preventive strategies that reduce long-term risk,” she continued.

Coronary heart disease risk in males develops in mid-30s

According to Freedman, standard risk factors, such as smoking, high blood pressure, and diabetes, have become more similar among males and females in recent decades. However, the gap for cardiovascular disease hasn’t narrowed.

Because of this, Freedman and her research team said that it’s important to look beyond these factors, such as blood pressure and cholesterol, and consider a broader range of social and biological factors. 

The researchers analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. The CARDIA study enrolled 5,100 adults between the ages of 18 and 30 in the mid-1980s and followed them through 2020. 

Participants were healthy young adults at enrollment. This enabled the scientists to pinpoint when cardiovascular disease risk first began to diverge between males and females. Males reached 5% incidence of cardiovascular disease around seven years before females. 

Incidence of cardiovascular disease is broadly defined to include heart attack, stroke, and heart failure. 

The difference between males and females was largely driven by coronary heart disease.

During the study, males reached 2% incidence of coronary heart disease more than 10 years before females. Rates of stroke were similar, and any differences in heart failure showed later in life. 

Cardiovascular risk may extend beyond traditional factors

The researchers looked at whether differences in the following factors could explain the earlier onset of heart disease in males: 

• cholesterol
• blood pressure
• blood sugar
• diet
• smoking
• physical activity
• body weight

Certain factors, such as high blood pressure, explained part of the gap. However, overall cardiovascular health did not account for the difference. This suggests that other biological or social factors may play a role. 

“Risk factors are crucial in understanding cardiovascular health, but younger men are a unique case,” Alptunear said. 

He added that hormonal differences between males and females may affect how lipids are handled and how stable or unstable atheroma are.

Males also have a propensity to gain more visceral fat than pre-menopausal females. This can increase the risk of insulin resistance, inflammation, and cardiovascular disease, according to Alptunear. 

Cheng-Han Chen, MD, board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, who wasn’t involved in the study, agreed.

“It is not clear what the driving factors are for the earlier development of heart disease in men,” he told Healthline. “It may be related to differences in the levels of estrogen, which appears to be protective of heart disease in women.”

Alptuner said that social and behavioral factors may influence cardiovascular risk.

“Men are more prone to postpone preventive measures, screen less often for health problems, and overlook early warning signs of fatigue, shortness of breath, or chest pain that occurs sporadically,” he said.

Cardiovascular risk in young males increases around age 35

One of the biggest findings from the study was the age in which the risk gap between males and females widened.

The researchers found that males and females had similar cardiovascular risks through their early 30s. 

However, around age 35, the risk for males began to rise more rapidly and remained higher through midlife. 

Historically, heart disease screening and prevention efforts have focused on people over the age of 40. However, this study suggests that this may be missing an important window. 

“It may also be related to men not getting check-ups as often as women, thereby missing out on opportunities to improve their cardiac risk factors,” Chen said.

The researchers also suggested that females may be more likely to attend routine check-ups than males. This may be due in part to gynecologic and obstetric visits. This unevenness in preventive care rates is a major challenge in closing the gap. 

“The most vital step is early detection and proactive risk management. Men shouldn’t take cardiovascular health seriously only after symptoms have started,” said Alptunear. 

“I advocate for early adulthood routine screening of blood pressure, cholesterol, blood sugar, and familial history, particularly for individuals with risk factors or strong familial histories.”

Reducing cardiovascular risk

In the press release, Freedman emphasized that cardiovascular disease remains the leading cause of death for both males and females. She added that prevention is critical for everyone. 

“Lifestyle changes are key. This means regular aerobic and resistance exercise, good sleep, stress management, no tobacco, and a heart-healthy diet high in fiber and unsaturated fats, lean protein,” said Alptunear.  

“Equally as important is establishing care with a provider who focuses on prevention, not just treatment,” he said.