Men’s risk of developing cardiovascular disease begins rising faster than women’s starting in the mid-30s, according to an analysis of the long-running CARDIA cohort. Researchers found men reached a 5% cumulative incidence of cardiovascular disease about seven years earlier than women, with coronary heart disease driving most of the gap; traditional risk factors explained only part of the difference.
A decades-long study that followed U.S. adults from young adulthood into midlife found that men’s cardiovascular disease risk begins to pull away from women’s around age 35.
Researchers analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which enrolled more than 5,100 Black and white participants ages 18 to 30 in the mid-1980s and followed them through 2020. Because participants were healthy at enrollment, investigators said the dataset allowed them to identify when men’s and women’s cardiovascular disease trajectories began to diverge.
According to the analysis, men reached a 5% cumulative incidence of cardiovascular disease—defined to include heart attack, stroke and heart failure—at about age 50.5, compared with about age 57.5 for women, a gap of roughly seven years.
Coronary heart disease accounted for most of the difference. Men reached a 2% cumulative incidence of coronary heart disease more than a decade earlier than women, the researchers reported. By contrast, the analysis found similar timing for stroke between men and women, and differences in heart failure appeared later. The authors noted the cohort was still relatively young at the end of follow-up—participants were under 65—which may limit how much later-life patterns can be detected.
The researchers examined whether conventional risk factors could explain the earlier rise in men, evaluating measures including blood pressure, cholesterol, blood sugar, smoking, diet, physical activity and body weight. They found that these factors, including higher rates of hypertension in men, accounted for part—but not all—of the difference, leaving the authors to call for broader investigation into additional biological and social contributors.
“That timing may seem early, but heart disease develops over decades, with early markers detectable in young adulthood,” said Alexa Freedman, an assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine and the study’s senior author.
The authors pointed to the American Heart Association’s PREVENT risk equations—which estimate cardiovascular risk beginning at age 30—as one potential tool for earlier assessment.
The report also highlighted a preventive-care gap among U.S. adults ages 18 to 44: women are more than four times as likely as men to attend routine checkups, largely due to gynecologic and obstetric visits. Encouraging preventive visits among young men could be an opportunity to identify risk earlier, the authors said.
The study was published January 28, 2026, in the Journal of the American Heart Association.
