Men develop premature heart disease earlier than women

By Vijay Kumar MalesuReviewed by Lauren HardakerFeb 2 2026

Researchers track heart disease from young adulthood to uncover when sex-based risk differences first emerge.

Study: Sex Differences in Age of Onset of Premature Cardiovascular Disease and Subtypes: The Coronary Artery Risk Development in Young Adults Study. Image credit: Pixel-Shot/Shutterstock.com

In a recent study published in the Journal of the American Heart Association, a group of researchers examined sex-based differences in the age of onset of premature cardiovascular disease (CVD) and its major subtypes across adulthood.

When do sex-based heart risk differences begin?

Heart disease is a leading cause of death in the United States (US), which often develops silently without showing any symptoms for decades. Various studies show that men are usually diagnosed earlier than women. Traditionally, hormones in women have been thought to protect them from various heart diseases, while men are at higher risk.

Now, changes in lifestyle and cardiometabolic health patterns have altered cardiovascular risk, with rising obesity, diabetes, and hypertension rates among women and declining smoking rates overall. It is unclear if these changes have made the CVD risks similar for both men and women in early life. Further research is needed to understand when and how these sex-based differences in heart risk develop.

Tracking cardiovascular disease from young adulthood onward

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.

Risk trajectories split in the mid-30s

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.

Lifelong prevention remains essential for both sexes

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.

Download your PDF copy now!