Men in Chicago and across the country may want to start taking their hearts a lot more seriously by their mid-30s. New long-term research led by Northwestern Medicine finds that men’s cardiovascular risk begins to accelerate around age 35, years earlier than many current screening guidelines might suggest. Over more than three decades of follow-up, men in the study reached a roughly 5 percent cumulative incidence of cardiovascular disease at about age 50.5, roughly seven years sooner than women, who hit the same mark near age 57.5. That gap was driven mostly by coronary heart disease and signals that earlier prevention and screening could meaningfully change outcomes for men.
The analysis, titled “Sex Differences in Age of Onset of Premature Cardiovascular Disease and Subtypes: The Coronary Artery Risk Development in Young Adults (CARDIA) Study,” was published Jan. 28 in the Journal of the American Heart Association. Researchers used CARDIA data on more than 5,100 Black and white adults who enrolled at ages 18 to 30 in the mid-1980s and were followed through 2020. With that long view, they were able to pinpoint the ages at which cumulative incidence crossed fixed thresholds for total cardiovascular disease and its major subtypes.
Gap Shows Up In The Mid-30s
“That timing may seem early, but heart disease develops over decades, with early markers detectable in young adulthood,” said Alexa Freedman in a Northwestern University news release. The investigators report that men and women had similar cardiovascular risk through their early 30s, then men’s risk started to climb faster around age 35 and stayed higher through midlife. Coronary heart disease accounted for most of the earlier onset seen in men, while stroke showed little difference in timing between men and women.
PREVENT Tool Points To Earlier Screening
The authors highlight the American Heart Association’s PREVENT risk equations, which generate 30-year risk estimates and age-and-sex percentiles, as one way to identify younger adults who might benefit from preventive care, according to JACC research. Presenting long-term risk in percentiles can make the numbers feel more concrete than a standard 10-year estimate and can help clinicians decide when to start lifestyle counseling or medication interventions earlier in adulthood.
Why Men May Miss The Early Window
One practical hurdle is that younger women are much more likely to be in regular contact with the health care system for reproductive services. The study notes that women ages 18 to 44 are more than four times as likely as men to attend routine checkups, per Northwestern University. That gap in preventive visits can leave men without the early blood pressure checks, cholesterol screening, or counseling about smoking and weight that might head off problems later. The investigators also examined traditional risk factors and found that while hypertension explained part of the sex gap in timing, overall cardiovascular health did not fully account for the earlier onset of disease in men, according to the paper.
What Clinicians And Men Can Do Now
The authors and outside cardiologists say clinicians should consider assessing long-term risk earlier and using tools that show 30-year percentiles to guide discussions about lifestyle changes and, when appropriate, treatment for blood pressure or lipids, as described in JACC research on PREVENT. For men, that can mean bringing up heart risk with a primary care clinician in the mid-30s instead of waiting for a “middle-age” checkup, checking blood pressure at home, and talking through family history and smoking status.
The Northwestern-led CARDIA analysis adds to growing evidence that heart disease prevention is a life-course effort, not a surprise plot twist in midlife. Coverage of the findings includes reporting by Chicago Business, and the full study appears in the Journal of the American Heart Association.
