Experts have recommended that screening for heart attack risk in men should start earlier than for women, warning that cardiovascular disease (CVD) starts climbing when men are in their mid-30s.
For their recent study, which was published in the Journal of the American Heart Association, the US-based researchers followed the health of 5 112 people for an average of around 34 years. As the participants were healthy and aged 18-30 when the study started in the mid-1980s, the study team could chart cases of CVD (including strokes and heart failure) over time.
According to the data, 35 is the critical age when disparities between male and female CVD risk start to appear. Most of the difference is driven by coronary heart disease (CHD), the most common cause of heart attacks, where fatty deposits clog up arteries, blocking blood flow.
“That timing may seem early, but heart disease develops over decades, with early markers detectable in young adulthood,” said epidemiologist Alexa Freedman from America’s Northwestern University.
“Screening at an earlier age can help identify risk factors sooner, enabling preventive strategies that reduce long-term risk.”
After accounting for other contributory factors, including blood pressure, cholesterol, blood sugar levels, smoking status, physical activity, and body weight, the gap was lessened – but it didn’t disappear, suggesting there's more to the story.
The data showed that men reach a 5% incidence level of cardiovascular disease about seven years earlier than women, or 50.5 years versus 57.5 years, on average. For CHD specifically, a 2% incidence is reached in men a decade before women.
For stroke risk, there was little difference between men and women, and the gap for heart failure (where the heart isn’t pumping as well as it should be) started to emerge later in life, findings upon which future studies may be able to build.
“This was still a relatively young sample – everyone was under 65 at last follow-up – and stroke and heart failure tend to develop later in life,” Freedman said.
While the study didn’t go into the reasons for the discrepancy between men and women in much detail, differences in sex hormones and cholesterol levels may be partly responsible.
The 10-year difference in CHD risk between the sexes has been reported before, but this new study analysed more recent data and expanded upon previous analyses to include multiple kinds of cardiovascular disease.
Given that women are more likely to regularly visit health professionals for check-ups, and men have such a significant head start when it comes to heart attack risk, the researchers are hoping to see more done to encourage men to get their heart health assessed at an earlier age.
“Our findings suggest that encouraging preventive care visits among young men could be an important opportunity to improve heart health and lower cardiovascular disease risk,” said Freedman.
Study details
Sex Differences in Age of Onset of Premature Cardiovascular Disease and Subtypes: The Coronary Artery Risk Development in Young Adults Study
Alexa Freedman, Laura. Colangelo, Hongyan Ning et al.
Published in Journal of the American Heart Association on 28 January 2026
Abstract
Background
Historical data indicate men develop coronary heart disease (CHD) 10 years before women. However, whether this sex gap persists in a contemporary sample amid changing cardiometabolic risk profiles, and whether differences exist for other cardiovascular disease (CVD) subtypes (ie, stroke, heart failure), is not known.
Methods
Data are from the CARDIA (Coronary Artery Risk Development in Young Adults) study, a prospective multicentre cohort study. US adults aged 18 to 30 years enrolled in 1985 to 1986 and were followed through August 2020. Sex differences in the cumulative incidence functions of premature CVD (onset <65 years), overall and for each subtype (CHD, heart failure, stroke), were compared using Gray’s test.
Results
Among 5112 participants (54.5% female, 51.6% Black) with a mean age of 24.8 years (SD: 3.7) at enrolment and a median follow‐up of 34.1 years (interquartile range, 33.8–35.7), men had a significantly higher cumulative incidence of CVD, CHD, and heart failure (P<0.05 for all), with no difference in stroke (P=0.63). Men reached 5% incidence of CVD 7.0 years earlier than women (50.5 versus 57.5 years, P<0.001). CHD was the most frequent CVD subtype, and men reached 2% incidence 10.1 years earlier than women (P<0.001). Men and women reached 2% stroke and 1% heart failure incidence at similar ages. Ten‐year CVD event rates diverged at an index age of 35.
Conclusions
Men developed CVD earlier than women, with the greatest difference observed for CHD. Sex differences in CVD risk emerged at 35, persisted through midlife, and were not attenuated by accounting for cardiovascular health.
See more from MedicalBrief archives:
Scientists find 16 genes that increase women’s heart attack risk
Numerous heart attacks being missed – US-Canada analysis
Sex differences in ‘normal’ blood pressure and associated CVD risk