Heart disease is the leading killer of both men and women, claiming the lives of nearly half a million Americans every year. While some women may not take heart disease seriously enough, most males–especially those over age 40–feel vulnerable. And with good reason.

From 1949 to the mid-1970s, according to researchers at Bristol University in England, heart-related deaths among males increased steadily, not only in Great Britain but the United States, France, Sweden and Australia. During that same period, heart disease mortality among women remained stable or declined slightly. From the mid-1970s until today, that trend has been reversed, with overall heart attack deaths declining and the gender gap closing significantly.

Treatment has improved, and Americans now know more about the risk factors and what they can do to delay or prevent the onset of heart disease. One of those risk factors is smoking, and men have always smoked more than women. But as more Americans choose to quit smoking, the gender gap among smokers has also narrowed.

The major difference between men and women in heart attack risk is usually explained in terms of hormones. Starting at puberty and lasting until menopause around age 50, women tend to have better cholesterol profiles than men. Whereas men face the possibility of a life-threatening attack starting at age 40 or even earlier, women have a lower risk until at least age 50, after which time their vulnerability begins to resemble that of males.

Not All Biology
The increased risk faced by males varies from country to country, however, and these differences cannot be explained so readily by biology. In Iceland, 10 times as many men as women die from heart disease; in China that ratio is only 10:6. Russian males die of heart-related causes at a rate of 500 per 100,000; yet French males have a mortality rate similar to that of American women, 80 per 100,000.

Over the past decade, while heart attack mortality has been steadily declining in the United States and Western Europe, males in Russia and other countries of the former Soviet Union have witnessed a virtual epidemic. Life expectancy for Russian men declined by 5.9 years during the period from 1990 to 1994–with most of that change attributed to heart disease. Heart-related deaths increased 30.9 percent among men and 16.6 percent among women during that period while cancer deaths remained virtually unchanged for both men and women.

Comparative studies have failed to find an explanation in terms of environment (such as air pollution) or heart disease risk factors (such as diet, obesity, smoking). This period, however, was a time of major social change in these countries. Per capita income declined by about two thirds, and the poverty rate went from 2 percent in 1987 to 38 percent in 1993.

In the United States, the highest rates of heart disease mortality are in areas with high unemployment, low income and limited access to health care. In one of these areas, the so-called “Coronary Valley” of Kentucky, a telephone survey found that most residents were aware of traditional risk factors for heart disease, but did not necessarily follow guidelines. Rates of smoking and obesity remained high. One possible explanation, according to the authors, is that “individuals with CHD may cope with their disease by either denying the association between risky behaviors and disease outcome or by being fatalistic about their survival.”

A study comparing men in Lithuania and Sweden found similar rates of smoking, obesity, hypertension and high cholesterol in the two countries even though Lithuanian males were four times more likely to die from heart disease. Lithuanian men reported higher levels of depression and exhaustion with less social support, social integration and coping strategies.

Persons with depression–both men and women–are three to four times more likely than others to die of heart-related causes. But even though women may have higher rates of depression, they also are more willing to seek help through treatment or the support of friends. Men, studies show, are more likely to deny their depression, distract themselves with other activities or drown their sorrows with alcohol.

When faced with disruptive life situations, such as divorce or loss of a job, a woman is more likely than a man to have an extensive social network to turn to for support. According to the Male Aging and Women’s Health studies, 24.2 percent of middle-aged males but only 6.1 percent of females, said their spouse or partner was their only source of support.

Stress and the Corporate Ladder
Although stress is not officially recognized as a major risk factor for heart disease, it clearly can take a toll on the body.

Adrenaline and other stress hormones make the heart beat faster and can, at least temporarily, cause blood pressure to rise, arteries to narrow and blood to clot.

In the 1950s, public perception often linked heart attacks to job stress among “type A” executives. Some speculated that as women moved into upper level positions, they would also inherit a greater risk for heart disease–a theory that was largely refuted by research.

Most studies show that heart-related risk is associated with jobs much lower on the corporate ladder–jobs that combine high demand and low reward. A study of more than seven thousand civil servants in Great Britain found that lower level workers had a heart attack risk 50 percent greater than that of administrators. The authors concluded that lack of control over the work environment was the “most important socioeconomic factor that increased the risk of coronary heart disease.”

Stress, hostility, anger, social isolation, depression–all are known to affect an individual’s well being. Whether you’re a man or a woman, it’s important to manage not only behaviors that are known to influence cardiovascular health–such as smoking, diet, weight and exercise–but your personal environment and your reaction to stress.

REFERENCES:
“Abdominal Fat Equalizes Gender Differences for Daytime Triglycerides,” Women’s Health Weekly, January 31, 2002.
Kathy Berra, “Women, Coronary Heart Disease, and Dyslipidemia: Does Gender Alter Detection, Evaluation, or Therapy?” Journal of Cardiovascular Nursing, January, 2000.
“Environmental Factors Could Even Out Gender Differences in Heart Disease Risk,” Health & Medicine Week, October 8, 2001.
“First Atlas of Geographic and Racial, Ethnic Disparities in Heart Disease Death Rates for U.S. Men Released,” Heart Disease Weekly, July 8, 2001.
Margareta Kristenson, et al, “Antioxidant State and Mortality from Coronary Heart Disease in Luthuanian and Swedish Men: Concomitant Cross Sectional Study of Men Aged 50,” British Medical Journal, March 1, 1997.
M.G. Marmot, et al, “Contribution of Job Control and Other Risk Factors to Social Variations in Coronary Heart Disease,” The Lancet, July 26, 1997.
Karen A. Matthews and Brooks B. Gump, “Chronic Work Stress and Marital Dissolution Increase Risk of Posttrial Mortality in Men from the Multiple Risk Factor Intervention Trial,” Archives of Internal Medicine, February 11, 2002.
Egle Narevic and Nancy E. Schoenberg, “Lay Explanations for Kentucky’s ‘Coronary Valley,’” Journal of Community Health, February, 2002.
Francis C. Notzon, et al, “Causes of Declining Life Expectancy in Russia,” JAMA, March 11, 1998.
Cathy Perlmutter, “The Heart of the Matter,” Prevention, February, 1998.
Joan L. Thomas and Patricia A. Braus, “Coronary Artery Disease in Women: A Historical Perspective,” Archives of Internal Medicine, February 23, 1998.
S. Goya Wannamethee, et al, “Influence of Fathers’ Social Class on Cardiovascular Disease in Middle-Aged Men,” The Lancet, November 9, 1996.
Gerdi Weidner, “Why Do Men Get More Heart Disease than Women? An International Perspective,” Journal of American College Health, May, 2000.
Alan White and Lesley Lockyer, “Tackling Coronary Heart Disease: A Gender Sensitive Approach Is Needed,” British Medical Journal, November 3, 2001.