The risk of acute myocardial infarction in men appears to increase as early as the mid–third decade of life, approximately seven years earlier than in women, according to a recent long-term epidemiological study. This finding challenges the prevailing view that the rise in cardiovascular risk among men begins after the age of 40.
It has been well established for decades that men develop cardiovascular diseases at a younger age compared with women. Although recent years have seen a convergence of major risk factors—such as smoking, hypertension, and diabetes mellitus—between the two sexes, the gap in the incidence of coronary artery disease persists. Coronary artery disease is the most frequently diagnosed form of heart disease, the leading cause of acute coronary syndromes worldwide, and the primary cause of mortality in both men and women.
The 30-year study was conducted in the United States under the supervision of the Northwestern University Feinberg School of Medicine and included more than 5,100 healthy Black and White adults aged 18–30 years at baseline. Participants were followed from the mid-1980s through 2020.
The findings showed that men begin to develop signs of coronary artery disease at a younger age, with the first clear sex-specific differences becoming evident around the age of 35. Specifically, men reached a cumulative incidence of cardiovascular disease of 5% approximately seven years earlier than women (50 versus 57 years). This difference was primarily attributable to coronary artery disease, as a 2% incidence was observed in men more than a decade earlier than in women. In contrast, the incidence of stroke was similar between the sexes, while differences in heart failure emerged at older ages.
Determinants of the observed disparity
The researchers examined whether traditional cardiovascular risk factors—including blood pressure, lipid levels, glycemic status, smoking, dietary quality, physical activity, and body mass index—could account for the earlier onset of heart disease in men. Although certain factors, particularly hypertension, partially explained the disparity, overall cardiovascular health was insufficient to fully account for it, suggesting the involvement of additional biological and social mechanisms.
Up to the age of 30, men and women exhibited comparable cardiovascular risk. However, from approximately 35 years of age onward, risk increased more rapidly in men and remained higher through midlife.
As noted by Dr. Alexa Friedman, Associate Professor of Preventive Medicine at Northwestern University Feinberg School of Medicine and lead author of the study published in the Journal of the American Heart Association, this early timing should not be considered unexpected.
The need for earlier preventive screening
“Cardiovascular disease develops gradually over decades, with early pathophysiological markers detectable as early as young adulthood,” Dr. Friedman explains, emphasizing that timely preventive screening allows for the implementation of targeted interventions that reduce long-term cardiovascular risk.
Although many contemporary prevention programs focus on individuals over the age of 40, the present findings suggest that this approach may overlook a critical window for primary prevention, particularly among young men. Encouraging regular preventive medical evaluations at younger ages could play a key role in improving cardiovascular health and reducing the overall burden of cardiovascular disease.