The development of atherosclerosis is very different in males versus females. In the commonly used mouse models that develop atherosclerotic plaque in response to a high fat diet this is very evident. Interestingly, ovariectomized female mice develop plaque in a very similar way to male mice, indicating the importance of hormones to the mechanisms of atherosclerosis. In humans, atherosclerosis is broadly a male condition up to the age of menopause, at which point women start to catch up to the male extent of atherosclerotic plaque and subsequent cardiovascular disease and mortality.
Cardiovascular disease (CVD) is the leading cause of death for both men and women in the United States, though the age of onset differs by sex. Historical estimates suggest men experience earlier onset of coronary heart disease (CHD) by about 10 years as compared with women. Sex-specific differences in CVD are attributed to multiple different pathways, including hormonal influences, differences in cardiovascular health behaviors and factors, and exposure to adverse social determinants of health. Historically, men had higher rates of smoking, diabetes, and hypertension. However, population shifts in cardiometabolic risk phenotypes have resulted in similar or higher rates of obesity, diabetes, and hypertension in women than men. Additionally, the overall prevalence of smoking has decreased and is similar among men and women.
This study analysed data from the CARDIA (Coronary Artery Risk Development in Young Adults) study, a prospective multicenter cohort study. US adults aged 18 to 30 years enrolled in 1985 to 1986 and were followed through August 2020. Sex differences in the cumulative incidence functions of premature CVD (onset earlier than 65 years), were compared overall and for each subtype (CHD, heart failure, stroke).
Among 5,112 participants with a mean age of 24.8 ± 3.7 years at enrollment and a median follow-up of 34.1 years, men had a significantly higher cumulative incidence of CVD, CHD, and heart failure, with no difference in stroke. Men reached 5% incidence of CVD 7.0 years earlier than women (50.5 versus 57.5 years). CHD was the most frequent CVD subtype, and men reached 2% incidence 10.1 years earlier than women. Men and women reached 2% stroke and 1% heart failure incidence at similar ages. Sex differences in CVD risk emerged at age 35, persisted through midlife, and were not attenuated by accounting for cardiovascular health.
Link: https://doi.org/10.1161/JAHA.125.044922
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