Men’s Heart Risk Diverges by Mid-30s, Long Study Suggests Earlier Cardiovascular Turning Point

A long-running U.S. cohort study indicates that men begin to experience a higher short-term risk of cardiovascular disease from around age 35, several years earlier than women. The findings add nuance to the long-cited “10-year gap” in heart disease and raise questions about how early prevention and screening should begin.

Cardiovascular disease is often framed as a later-life concern. Yet evidence from a multi-decade U.S. study suggests that the divergence in heart risk between men and women begins much earlier than commonly assumed, with measurable differences emerging in the mid-30s.

Published in the Journal of the American Heart Association, the research followed more than 5,000 adults from young adulthood for over three decades. It found that men reached clinically significant levels of cardiovascular disease roughly seven years earlier than women. The divergence did not appear in early adulthood but began to widen from around age 35, according to rolling 10-year risk estimates.

The findings do not suggest that women are at low risk, nor that traditional risk factors explain the entire gap. Rather, they point to a shift in when risk becomes detectable and to the potential importance of earlier engagement with preventive care—particularly for men who are less likely to access routine health services in early adulthood.

Tracking risk from the starting line of adulthood

The study draws on data from the long-running Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort established in 1985–86. Researchers enrolled 5,112 Black and White adults aged 18 to 30 across four U.S. states, all free of cardiovascular disease at the outset.

Participants underwent regular clinical assessments and surveys for a median of 34 years. Over that period, 227 men and 160 women experienced cardiovascular events including coronary heart disease, stroke, and heart failure.

Because participants entered the study before most cardiovascular risk factors had emerged, researchers were able to identify more precisely when disease began, rather than relying on retrospective data from older adults. That long observational window allowed the team to examine how short-term risk evolved with age.

The mid-30s divergence

Rather than estimating lifetime risk, the researchers used rolling 10-year risk windows at each age. Up to the early 30s, men and women showed similar short-term cardiovascular risk. From around age 35, however, the curves began to separate.

By age 50, the estimated 10-year cardiovascular risk was roughly 6% for men compared with about 3% for women. Over the full follow-up period, around 5% of men had developed cardiovascular disease by age 50. Women reached that same cumulative level closer to age 57.

For coronary heart disease in particular, the traditional “10-year gap” was clearly visible. Around 2% of men had developed coronary heart disease by their late 40s, while women did not reach that level until their late 50s.

This distinction matters because coronary heart disease—a narrowing or blockage of the heart’s arteries due to plaque buildup—has historically driven much of the observed sex difference in cardiovascular outcomes.

Not fully explained by traditional risk factors

One of the study’s notable findings is that the earlier onset in men was not explained by conventional risk markers such as blood pressure, cholesterol levels, or smoking status.

Historically, higher smoking rates and differences in hypertension prevalence were used to explain part of the sex gap. Today, those differences have narrowed substantially between men and women, suggesting other influences may be at work.

Experts not involved in the study point to the role of biological differences and social determinants that are difficult to quantify. These may include variations in stress exposure, occupational patterns, hormonal influences, and differences in how men and women interact with health systems.

The absence of a clear explanation from traditional risk metrics underscores the limits of current cardiovascular models and suggests that sex-specific biological or environmental factors may be under-recognized.

Stroke and heart failure tell a different story

The divergence was not uniform across all types of cardiovascular disease.

For stroke, men and women reached similar incidence rates at roughly the same ages. Heart failure showed little difference earlier in life, although men had slightly higher incidence by age 65.

This indicates that the early divergence is primarily driven by coronary heart disease rather than all cardiovascular conditions. That nuance challenges the blanket idea of a universal “10-year gap” and refines it to specific disease pathways.

Hormonal timing and the later catch-up

Researchers and cardiologists note that women’s cardiovascular risk often accelerates after menopause. Estrogen is believed to have a protective effect on blood vessels and lipid profiles, which may delay the onset of coronary disease.

The average age of menopause in the U.S. is around 52. After this transition, women’s cardiovascular risk begins to rise more rapidly, narrowing the earlier gap observed in midlife.

This dynamic helps explain why women appear protected earlier but remain at substantial lifetime risk. Cardiovascular disease remains a leading cause of death for women as well as men.

Preventive care patterns may amplify the gap

Another factor highlighted by the study is health-care utilization. Young adult women tend to have more regular preventive health visits, often linked to reproductive health care. These interactions may create more opportunities for risk screening, counseling, and early intervention.

Young men, by contrast, are less likely to seek routine medical care in their 30s and 40s. This difference in engagement could mean that emerging risk factors go undetected for longer.

The findings arrive as cardiovascular guidelines increasingly emphasize earlier risk assessment. Updated American Heart Association risk equations now allow clinicians to estimate cardiovascular risk beginning at age 30 rather than 40, aligning with the study’s suggestion that measurable divergence begins in the mid-30s.

Implications without prescriptions

The research does not argue for sex-specific screening thresholds, nor does it claim that men are destined for earlier disease. Instead, it suggests that the window for meaningful prevention may open earlier than many assume, particularly for men.

Experts emphasize that both sexes should monitor blood pressure, cholesterol, and blood sugar from early adulthood and pay attention to lifestyle factors including sleep, diet, physical activity, and tobacco use—captured in the American Heart Association’s “Life’s Essential 8.”

The broader implication is about timing: when individuals and health systems begin paying attention to cardiovascular risk.

A more precise understanding of the “gap”

For decades, the “10-year gap” between men and women in heart disease has been widely cited. This study refines that concept. The gap is evident for coronary heart disease, emerges in the mid-30s rather than later adulthood, and is not clearly explained by the usual risk factors.

That more precise timeline could influence how clinicians think about risk discussions with younger patients and how public health messaging frames heart disease prevention across the life course.

At the same time, researchers caution that the findings apply to the studied population and that further work is needed to understand underlying biological and social mechanisms.

What the study ultimately offers is not a verdict but a reframing: cardiovascular risk is not simply a midlife issue, and for men in particular, the turning point may arrive earlier than expected.