The Heart Disease Gender Gap: What All Men Should Know About CAD

As board-certified vascular specialists who provide comprehensive care for patients with peripheral artery disease (PAD) and carotid artery disease, our team at Advanced Vascular Surgery knows that the same mechanisms and risk factors behind these vessel-blocking conditions are also responsible for coronary artery disease (CAD). 

In recognition of Men’s Health Month this June, we’re here to shed light on why men have a higher risk of developing CAD (and related conditions) at earlier ages compared with women, and how a few targeted lifestyle changes can help mitigate that risk and keep you healthy. 

Coronary artery disease explained

CAD develops when the arteries that supply blood to the heart muscle become hardened and narrowed by the buildup of plaque (cholesterol, fat, and other substances) along their inner walls. This vessel-damaging buildup is called atherosclerosis. 

CAD is known as a “silent killer” because atherosclerosis can progress for years before the plaque buildup restricts blood and oxygen enough to cause chest pain (angina) or triggers a blood clot that breaks away from the vessel wall and causes a heart attack. 

Why men develop CAD earlier in life

CAD is the most common form of heart disease and a leading cause of death in the United States for older adults, both men and women alike. But when it comes to CAD risk among younger adults, there’s a bit of a gender gap, and men have a measurable disadvantage.   

First, it’s important to recognize that nearly half of all American adults have at least one of the following three key risk factors for CAD:

• High blood pressure
• High cholesterol levels
• Smoking cigarettes 

Another major risk factor for CAD? Getting older. But while a woman’s CAD risk begins to increase at the age of 55, a man’s CAD risk starts rising substantially a full decade earlier, around the age of 45. This is due to a combination of factors: 

Biological factors 

The main female sex hormone, estrogen, offers significant protection against arterial plaque buildup — this is why women’s CAD risk starts increasing after estrogen levels decline during menopause. Men lack this protection, so their arteries are more vulnerable to atherosclerosis at a younger age. 

Health factors 

More men than women have Type 2 diabetes, another top risk factor for atherosclerosis and CAD. Men also tend to develop diabetes at an earlier age than women. Men are also more likely to develop major CAD risk factors like hypertension, high cholesterol, and abdominal obesity earlier in life.     

Behavioral factors

Men are more likely than women to engage in unhealthy behaviors that contribute to CAD development, like smoking and vaping (tobacco use) and drinking alcohol. 

Women also tend to eat healthier than men, opting for foods like fruits, vegetables, whole grains, and lean proteins. In contrast, men are more likely to stick with a conventional “red meat and potatoes” approach, which can increase their CAD risk.

Psychosocial factors

Stress, which can cause your arteries to tighten, is another CAD risk factor, especially when it triggers unhealthy eating patterns, smoking, or drinking. 

Women are more likely to report high stress levels compared with men, but men are more likely to cope with stress in ways that can increase their CAD risk, by withdrawing socially, becoming angry, sleeping less, or turning to substance use.

The systemic nature of atherosclerosis

Atherosclerosis, the disease process caused by plaque buildup, is the primary underlying cause of many cardiovascular diseases, in addition to CAD. It’s not uncommon for people with CAD to also have one or more of the following:

• Carotid artery disease, affecting the neck and brain
• Peripheral artery disease, affecting the extremities
• Renal artery stenosis, affecting kidney function 
• Vertebral artery disease, affecting the back of the brain 
• Mesenteric artery ischemia, affecting the intestines

Owing to the systemic, wide-ranging nature of atherosclerosis, it’s not surprising that for men, erectile dysfunction is a common early sign of cardiovascular disease. Like the heart, the penis is a vascular organ. Given that its arteries are much smaller, however, damage often appears there first, often years before other signs of heart disease become evident. 

In fact, men in their forties who have erection problems — even in the absence of other heart disease risk factors — have an 80% risk of developing heart disease by their fifties. 

Taking charge of your vascular health

Luckily, there’s a lot you can do to take charge of your cardiovascular health and prevent or delay the development of atherosclerosis and its effects. A heart-healthy lifestyle means: 

• Reaching and maintaining a healthy body weight
• Managing blood pressure and cholesterol numbers
• Preventing or managing prediabetes/Type 2 diabetes 
• Getting regular exercise and eating a balanced diet 
• Reducing stress and managing stress more effectively 
• Avoiding or quitting smoking, limiting alcohol intake

To find out how we can help, schedule a visit at your nearest Advanced Vascular Surgery office in Kalamazoo, Allegan, Battle Creek, Coldwater, Sturgis, or Three Rivers, Michigan, today.