Men at Risk of Coronary Heart Disease Development 10 Years Before Women, With Alexa Freedman, PhD

An analysis of historical data from the Coronary Artery Risk Development in Young Adults (CARDIA) study has suggested that men develop coronary heart disease (CHD) up to 10 years before women.1

Sex-specific differences in cardiovascular disease have long been attributed to a variety of pathways, including hormonal influences, variations in cardiovascular health behaviors and factors, and exposure to adverse social determinants of health. Men historically have higher rates of smoking, diabetes, and hypertension – however, recent population shifts have resulted in similar rates among women. These shifts warrant a reexamination of existing data.2

“One of the things we noted in our study was that men are much less likely to receive preventive care in young adulthood,” Alexa Freedman, PhD, an epidemiologist in the department of preventive medicine at Northwestern University Feinberg School of Medicine, told HCPLive in an exclusive interview. “This might be an opportunity to enhance cardiovascular disease screening and prevention efforts in young men, as we see that risk starting to emerge earlier.”

CARDIA was a prospective cohort study which recruited 5115 Black and White participants between 18-30 years from March 1985 to June 1986. During the trial, health measures and surveys were collected at baseline, after which point patients completed examinations at study years 2, 5, 7, 10, 15, 20, and 30. Retention rates among surviving patients at each examination period were 91%, 86%, 81%, 79%, 74%, 72%, 72%, and 71%, respectively.2

CARDIA investigators defined incident cardiovascular disease as fatal or nonfatal myocardial infarction, stroke, heart failure, coronary revascularization, or carotid or peripheral arterial disease, among other conditions. Cardiovascular disease was also categorized into 3 subtypes – CHD, stroke, and heart failure. Cardiovascular disease events were determined at each visit and via annual contacts, during which participants reported any hospital admissions and outpatient procedures.2

For the purpose of this analysis, Freedman and colleagues evaluated 7 health behaviors and factors representing cardiovascular health. Behaviors included diet, physical activity, and smoking status – diet was assessed at baseline and years 7 and 20 via a questionnaire on dietary intake, while physical activity was determined based on frequency of participation in 13 moderate- and vigorous-intensity activities over the previous 12 months, and smoking status was determined via a questionnaire.2

Health factors investigated included body mass index (BMI), blood pressure, blood lipids, and blood glucose. BMI was calculated based on height in cm and weight in kg, measured at each visit. Blood pressure was measured in triplicate at each examination. Fasting lipids were determined via ethylene-diaminetetraacetic acid plasma at each examination, while fasting serum glucose was assessed with the hexokinase ultraviolet method at baseline.2

Of the 5112 patients included in the analysis, 2785 were women and 2327 were men. Mean age at baseline was 24.9 years (standard deviation [SD], 3.7) for women and 24.8 (SD, 3.6) for men. Over a median follow-up period of 34.1 years, there were 387 cardiovascular disease events – 160 among women and 227 among men.2

By the end of the analysis, investigators had noted significant differences between cumulative incidence for premature total cardiovascular disease among men and women. Men achieved cumulative incidence of 5% earlier than women by 7 years (P <.001); by age 50, the cumulative incidence was 4.7% among men and 2.9% among women. CHD was the most common form of cardiovascular disease, and male patients also reached cumulative incidence of CHD of 2% earlier than women by 10.1 years (P <.001), with a cumulative incidence of 2.5% by age 50 in men versus 0.9% among women.2

“One of the things I’ll note is that heart failure and stroke tend to develop later in life,” Freedman said. “We were looking at a sample where all participants were under 65 at the latest observation period, so we weren’t necessarily able to see those differences because we just didn’t have enough premature events in that sense. Those sex differences could emerge later in life.”

Editor’s Note: Freedman reports no relevant disclosures.

References

1. Wiley. Do men develop cardiovascular disease earlier than women? Eurekalert. January 28, 2026. Accessed January 30, 2026. https://www.eurekalert.org/news-releases/1113905

2. Freedman AA, Colangelo LA, Ning H, et al. Sex differences in age of onset of premature cardiovascular disease and subtypes: The coronary artery risk development in young adults study. Journal of the American Heart Association. Published online January 28, 2026. doi:10.1161/jaha.125.044922