Men’s heart disease risk starts rising in their mid-30s — years earlier than many doctors start looking.
- Men reached a 5% risk of cardiovascular disease about seven years sooner than women, highlighting a significant early gap in heart health.
- Coronary heart disease was the main reason for this difference, accounting for most of the earlier risk seen in men.
- Heart disease risk followed a similar path for men and women until about age 35, when men’s risk began to rise more quickly.
- The earlier onset in men cannot be explained by smoking, high blood pressure, or diabetes alone, suggesting other biological or social factors also play a role.
Men’s Heart Disease Risk Starts Earlier
Men begin developing coronary heart disease, which can lead to heart attacks, several years before women do, with differences showing up as early as the mid-30s, according to a large, long-term study led by Northwestern Medicine.
The results come from more than 30 years of follow-up and point to a clear takeaway. Heart disease prevention and screening may need to begin earlier in adulthood, especially for men.
“That timing may seem early, but heart disease develops over decades, with early markers detectable in young adulthood,” said study senior author Alexa Freedman, assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine.
“Screening at an earlier age can help identify risk factors sooner, enabling preventive strategies that reduce long-term risk.”
Why the Gap Between Men and Women Persists
Past research has consistently shown that men tend to develop heart disease earlier than women. In recent decades, however, common risk factors such as smoking, high blood pressure, and diabetes have become more similar between men and women. Because of that, researchers expected the gap to shrink.
Instead, the difference has remained. That finding was unexpected, Freedman said.
To understand why the gap continues, the research team says it may be necessary to look beyond standard measurements like cholesterol and blood pressure and consider a wider mix of biological and social influences.
The study will be published today (January 28) in the Journal of the American Heart Association.
Tracking Heart Disease From Young Adulthood
The researchers analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which began in the mid-1980s. The project enrolled more than 5,100 Black and white adults aged 18 to 30 and followed them through 2020.
Because participants were healthy when they entered the study, the researchers were able to identify when heart-related risks first began to separate between men and women. Men reached a 5% rate of cardiovascular disease, defined broadly to include heart attack, stroke, and heart failure, about seven years earlier than women (50.5 versus 57.5 years).
Most of this difference was driven by coronary heart disease. Men reached a 2% incidence of coronary heart disease more than 10 years before women did. Stroke rates were similar between the sexes, and differences in heart failure appeared later. “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 explained.
Limits of Traditional Risk Factors
The scientists looked at whether familiar risk factors could explain why men developed heart disease sooner. These included blood pressure, cholesterol, blood sugar, smoking habits, diet, physical activity, and body weight.
Some factors, especially high blood pressure, helped explain part of the gap. Still, overall cardiovascular health measures did not fully account for the earlier onset in men. This suggests that additional biological or social factors may be playing a role.
Age 35 Emerges as a Turning Point
One of the clearest findings involved the age at which risks began to diverge. Men and women showed similar cardiovascular risk through their early 30s. Around age 35, men’s risk increased more quickly and remained higher through midlife.
Many heart disease screening and prevention programs focus on adults older than 40. The new findings suggest that approach may overlook an important early window for intervention.
The authors point to the American Heart Association’s PREVENT risk equations, which can predict heart disease starting at age 30, as a useful tool for identifying risk earlier.
Preventive Care Gaps Among Young Adults
A major challenge in reducing the difference between men and women is uneven access to preventive care. Among U.S. adults ages 18 to 44, women are more than four times as likely as men to attend routine checkups, largely because of gynecologic and obstetric visits.
“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,” Freedman said.
She added that cardiovascular disease remains the leading cause of death for both men and women, making prevention essential for everyone.
Reference: “Sex Differences in Age of Onset of Premature Cardiovascular Disease and Subtypes: The Coronary Artery Risk Development in Young Adults Study” by Alexa A. Freedman, Laura A. Colangelo, Hongyan Ning, Jaclyn D. Borrowman, Cora E. Lewis, Pamela J. Schreiner, Sadiya S. Khan and Donald M. Lloyd‐Jones, 28 January 2026, Journal of the American Heart Association.
DOI: 10.1161/JAHA.125.044922
Freedman is supported by the National Heart, Lung, and Blood Institute (K01HL165038). CARDIA is conducted and supported by the National Heart, Lung, and Blood Institute in collaboration with the University of Alabama at Birmingham (75N92023D00002 & 75N92023D00005), Northwestern University (75N92023D00004), University of Minnesota (75N92023D00006) ,and Kaiser Foundation Research Institute (75N92023D00003).
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