Most people don’t spend their 20s, 30s or even 40s worrying about heart disease. You might think it’s something you can safely ignore until midlife and beyond. But new research suggests that for many men, the risk of heart disease may begin rising sooner than they — or even their doctors — realize.
A decades-long study led by Northwestern Medicine researchers, published this year in the Journal of the American Heart Association, revealed that men start developing cardiovascular disease (CVD) years earlier than women, with cardiac risk differences beginning as early as their mid-30s.
The researchers used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study — a large, long-running U.S. cohort that includes 5,115 Black and White men and women ages 18 to 30, from four U.S. cities, who signed up for the study in 1985 and 1986. None of the participants had cardiovascular disease at the start. Each attended a follow-up visit every two to five years for the next 30 years.
At each visit, researchers measured blood pressure, cholesterol and other heart health markers, while tracking diagnoses over time. “This allowed us to evaluate when CVD risk emerges — and how it differs between men and women,” said lead study author Alexa Freedman, an epidemiologist and assistant professor in the department of preventive medicine at Northwestern University Feinberg School of Medicine.
“Our findings show that differences in cardiovascular disease risk between men and women emerge by age 35,” Freedman said, suggesting that young adulthood is a critical time to start taking cardiovascular risk seriously — and implementing prevention strategies into your life.
What young men need to know about their heart risk
The biggest factor driving men’s earlier heart attack risk was a higher incidence of coronary heart disease (CHD), which happens when plaque builds up in the walls of the arteries of the heart.
The study showed that starting at age 35, men were nearly twice as likely as women to develop CVD within the next 10 years. That elevated risk remained consistent through midlife. By age 50, 4.7 percent of men in the study had developed CVD, compared with 2.9 percent of women, who didn’t reach that same risk level until age 57. For CHD specifically, 2.5 percent of men had developed it by age 50, compared with 0.9 percent of women — who took roughly a decade to reach the same rates.
Stroke risk was similar for men and women by age 50, affecting about 1.2 percent of each group, while differences in the risk of heart failure,a chronic condition that occurs when the heart has trouble pumping enough blood, were smaller and tended to appear later in life. By age 55, men were still about twice as likely to experience a heart-related event over the following decade. (That’s not to say women aren’t prone to heart trouble — their risk quickly catches up with age and women can be more likely than men to have a heart attack or chest pain with lower amounts of artery-clogging plaque.)
The study also looked at risk factors like smoking, high blood pressure and Type 2 diabetes, all of which contribute to higher CVD risk. Interestingly, the risk gap between men and women persisted even after accounting for differences in these factors, suggesting that conventional risk profiles don’t fully explain the discrepancy.
“We already knew that the risk of getting heart disease is higher among men,” said Srihari S. Naidu, a cardiologist and professor of medicine at New York Medical College. What experts didn’t know — and what this study sheds light on — was just how early that elevated risk begins.
One thing that’s important to note is that because some participants were still relatively young at the end of follow-up, researchers could not fully assess how sex differences affected these people later in life, particularly after menopause, which is when women’s CVD risk rapidly increases. In general, women see their quickest CHD risk increase around age 55, though some research suggests that those who experience early menopause in their 40s have a 40 percent increased risk of CHD over their lifetime compared with women who do not go through early menopause.
How early screening can help
Cardiovascular disease screening typically focuses on adults over 40. “Our results suggest that it may also be important to assess CVD risk in young adulthood,” Freedman said.
Cardiologists agree. “Age is not protective,” said Laxmi Mehta, a noninvasive cardiologist and director of Preventive Cardiology and Women’s Cardiovascular Health at the Ohio State University Wexner Medical Center. “Clinicians should not miss the critical window of risk prevention in younger patients, regardless of sex.”
Mehta said some physicians may rely too heavily on traditional risk calculators developed specifically for older adults, which don’t usually consider nontraditional risk factors — like autoimmune conditions, adverse pregnancy outcomes and elevated lipoprotein(a) levels — that can help give young people a fuller picture of their future heart attack risk.
For example, certain pregnancy complications, such as preeclampsia, postpartum hemorrhage, gestational diabetes or preterm birth, have been linked to a higher risk of developing heart disease later in life. Elevated levels of lipoprotein(a), a genetically inherited type of cholesterol not included in standard lipid panels, can also accelerate plaque buildup in the arteries and increase cardiovascular risk even in otherwise healthy people.
Considering a wider breadth of risk factors could help detect cardiovascular problems in younger people before symptoms develop. “‘If you see something, say something’ is good for an airport, but not a great strategy for a doctor, at least, not by itself,” said Roy Ziegelstein, a cardiologist at Johns Hopkins University School of Medicine.
What you can do to reduce your heart risk right now
The time to take action to prevent cardiovascular disease and heart attack — no matter your sex — is “now,” Mehta said. “It’s paramount to think of heart disease risk reduction not as a ‘to-do’ item for when you reach adulthood, but something that needs to be instilled in your daily routine starting as early as childhood.”
There are many lifestyle choices you can make to help reduce your heart risk in your 30s and beyond. Mehta recommends following the American Heart Association’s Life’s Essential 8 as a benchmark. These guidelines suggest:
- Adopting a heart-healthy diet
- Exercising often
- Quitting tobacco
- Achieving, or maintaining, a healthy weight
- Controlling unhealthy cholesterol levels
- Managing blood glucose levels
- Keeping blood pressure levels stable
- Getting enough quality sleep each night
The relationship between mental health and your heart is also often overlooked. Social isolation, loneliness and depression all affect “adherence to lifestyle changes, medications and other treatments, arguably making them as important as the components of the AHA’s Life’s Essential 8, which I argue should become Life’s Essential 9,” Ziegelstein said.
Even if all of those boxes are checked, don’t assume your risk is low, Naidu said. “Go to the doctor routinely, starting perhaps at age 30, to review your family history and other risk factors.” At the end of the day, Ziegelstein said, identifying and controlling risk factors is important for everyone.
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