Why Do Men Have First Heart Attacks Earlier in Life than Women?
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An African-American man clutches his chest while sitting on his livingroom sofa.

One in four men in the U.S. die from a cardiovascular event such as a heart attack, according to the Centers for Disease Control and Prevention. While heart disease is a leading cause of death across genders, men tend to have their first heart attack an average of 10 years earlier than women. 

But why? Especially since the overall rate of heart attacks have declined with healthier diets, more exercise, and less smoking?

Research shows that along with typical risk factors—such as high blood pressure, high cholesterol, and diabetes—men are at increased risk of heart attack earlier in life due to hormone changes, abdominal obesity, and emotional challenges in middle adulthood. 

During a heart attack, or myocardial infarction, blood flow to the heart is blocked, usually by a blood clot. This leads to tissue damage or death of the heart muscle. While a heart attack might seem like a sudden event, most are the result of chronic stressors on the heart and blood vessels.

Let’s break down men’s risk factors and discuss ways to reduce the chances of having a heart attack early in life. 

Early heart attack risk factors in men.

Hormone levels.

Hormones like estrogen and progesterone, which are higher in women before menopause, keep blood vessels healthy and lower the risk of heart disease. Men have less of these hormones, so they don't get the same heart protection.

The hormone testosterone, which is more common in men, can also protect the heart. However, men lose testosterone as they age, especially after 40. This decrease is associated with higher death rates in general, as well as more heart problems. 

You may be wondering, why not prescribe extra testosterone to counteract these effects? Unfortunately, there isn’t currently enough proof that this would fix the issue, and a high level of testosterone, such as in bodybuilders who take anabolic steroids, has been associated with negative effects, like heart attacks, strokes, and liver issues. Recent studies have shown that supplementing with low doses of testosterone is safe for men who have low testosterone levels.

Abdominal obesity.

While women are more likely to carry fat in their hips (think of a pear shape), men tend to carry fat in their belly (more like an apple’s shape). Belly fat, also known as visceral fat, contains inflammatory cells. It exists around your organs instead of just under your skin. 

Belly fat can heighten inflammation, worsen your cholesterol profile, and raise your blood sugar. This kind of fat is different from fat in other parts of the body, and can increase your chance of heart disease.  

Stress and anger.

It’s been shown that people who experience high levels of chronic stress have an increased likelihood of cardiovascular disease. This includes work- and family-related stress, as well as loneliness and social isolation. 

Anger, in particular, is a risk factor. Studies show that heart attack risk increases by five times in the two hours after an angry outburst. Because of the effects of testosterone, men are more likely to struggle with managing their anger. 

Related Reading: Who’s at Risk for Heart Disease?

Signs of early heart disease in men.

As a cardiologist, I’ve seen many people ignore or downplay signs and symptoms of heart disease early in life. However, not all the signs of early heart disease in men are obvious. Sexual health, for example, isn’t just a quality-of-life concern—it can also be an early warning sign of heart disease:

  • Erectile dysfunction is the “canary in the coal mine” of heart disease. It’s often the first sign that something is wrong. While many people with low testosterone have erectile dysfunction, erectile dysfunction is only rarely due to low testosterone. It can also be a vascular problem—if the small blood vessels of the penis are blocked, it’s likely that larger blood vessels leading to the heart are also at risk of blockage.
  • Low sex drive can be a sign that your testosterone levels are decreasing, which can increase the risk of heart disease.
Some more immediate symptoms of heart attacks and heart disease in both men and women include:
  • Angina, a type of chest pain, which often feels like a tightness or heaviness in the chest
  • Excessive sweating, including a cold sweat
  • Trouble breathing 
  • Severe indigestion, heartburn, nausea, vomiting
  • Pain that spreads from the chest to the arms, neck, jaw, belly, or back

There are also irregular heart attack symptoms, including excessive fatigue, heart palpitations, and pain in the upper shoulder, or back. It’s worth noting that while irregular heart attack symptoms are more common in women, men also may feel them. If you have any of these symptoms, regardless of gender, call 911.

Related Reading: Are Symptoms of Heart Disease in Women Different Than in Men?

Tips to reduce your risk of an early heart attack.

  • Quit smoking: It’s well documented that smoking increases heart disease risk. Chemicals you inhale when you smoke can damage the heart and blood vessels. Stopping smoking can prevent further damage to your cardiovascular system. 
  • Drink less alcohol: Belly fat is often associated with alcohol use, and abdominal obesity is one of the biggest risk factors of heart disease. Cutting down on alcohol has numerous health benefits, including potential weight loss and decreased risk of heart disease. 
  • Get help to manage stress: Therapy, work-life balance, and healthy sleep habits can all decrease your stress levels. Talk with your doctor to make a personalized stress management plan. 
  • Exercise: The American Heart Association recommends at least 150 minutes of exercise per week. Even small lifestyle changes, such as going for daily walks, can decrease your chance of heart disease.
  • Eat healthy: Every individual is unique, and our food needs are, too. Rather than trying fad diets, make healthy choices over time in a way that’s sustainable for you. For example, eat less red meat and more vegetables like the heart-healthy Mediterranean diet. Work with a doctor, or dietitian to find an eating pattern that works for you.
If you suspect you may have heart disease, don't wait for symptoms to get worse. Reach out to a healthcare provider right away to discuss your options. Heart disease can affect anyone at any age, and men are particularly at risk early in life. The earlier we intervene, the better your chances of preventing a heart attack.

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