A group of researchers examined sex-based differences in the age of onset of premature cardiovascular disease (CVD) and its major subtypes across adulthood.
Study
Data were drawn from the Coronary Artery Risk Development in Young Adults study, a prospective, multicenter cohort that enrolled Black and White adults aged 18 to 30 years from four US cities between 1985 and 1986. Participants underwent repeated clinical examinations and health assessments over more than three decades, with ongoing surveillance for cardiovascular outcomes through August 2020, and sex was self-reported at enrollment.
The main study outcome was new-onset of clinically confirmed CVD, such as heart attack, stroke, heart failure, coronary revascularization, transient ischemic attack, or other adjudicated cardiovascular events. Events occurring before age 65 were classified as premature. CVD subtypes included coronary heart disease, stroke, and heart failure.
Cardiovascular health was assessed using seven metrics scored using the American Heart Association’s Life’s Essential 8 framework, excluding sleep due to unavailable baseline data. These measures included lifestyle and clinical factors such as diet quality, physical activity, smoking status, body mass index, blood pressure, blood lipid (non-high-density lipoprotein cholesterol), and glucose levels.
Time-to-event analyses accounted for competing non-cardiovascular deaths, and cumulative incidence and 10-year event rates were compared between men and women using standard competing-risk statistical methods.
Findings
Among 5,112 participants followed for a median of more than 34 years, just over half were women, and approximately half identified as Black. Men and women were roughly the same age at enrollment, but men had higher systolic blood pressure and a lower healthy heart score than women, whereas women were more educated than men.
Sex-based differences were evident in the timing of premature CVD, as men developed CVD significantly earlier than women, reaching a 5 % cumulative incidence approximately seven years sooner. Among men, almost 5 % had a cardiovascular event by the age of 50 years, compared with less than 3 % of women. These differences were consistent across racial and educational subgroups.
Coronary heart disease accounted for most of the observed disparity. Men reached a 2 % cumulative incidence of coronary heart disease more than 10 years earlier than women, reinforcing long-standing observations that coronary disease strikes men earlier in life.
No such significant sex differences were seen for the timing and frequency of stroke; men had similar risk levels at comparable ages as women. Heart failure showed modest sex differences overall, with cumulative incidence diverging later in life and higher incidence among men by age 65.
Ten-year cardiovascular event rates revealed when risk trajectories began to diverge. Until the early 30s, men and women had similarly low absolute risk. However, starting at approximately age 35, men consistently showed higher 10-year CVD rates than women. For example, among individuals free of disease at age 50, men had nearly double the 10-year risk compared with women. This divergence persisted through midlife and was evident for coronary heart disease as well.
It was also observed that even after adjusting for time-updated cardiovascular health measures, including blood pressure, cholesterol, glucose, smoking, physical activity, diet, and body mass index, men were still at higher risk of early heart disease. This suggests that traditional risk factors do not fully explain why men develop CVD earlier than women.
Conclusion
Men develop premature CVD earlier than women, largely due to the significantly earlier onset of coronary heart disease. These sex differences emerge as early as the mid-30s and persist through middle adulthood, even after accounting for cardiovascular health.
The findings highlight young adulthood as a critical period for cardiovascular risk assessment and prevention in men, when early intervention may help delay the onset of disease, while heart disease prevention remains equally important for women throughout their lifespan.
Source:
https://www.news-medical.net/news/20260202/Men-develop-premature-heart-disease-earlier-than-women.aspx