Heart disease continues to dominate as the leading cause of death among men worldwide, a troubling reality that persists despite significant advancements in medicine and awareness campaigns. Dr. Prashant Nair, Consultant, Cardiology, at Kokilaben Dhirubhai Ambani Hospital in Mumbai, explains why men remain particularly vulnerable to cardiovascular disease and what can be done to address this ongoing health crisis.

Age and Gender

“Men tend to develop cardiovascular disease earlier than women, often by a decade,” notes Dr. Nair. Research shows that coronary heart disease (CHD) is more prevalent in men until about the age of 75. This earlier onset has cemented the misconception that heart disease is primarily a man’s issue, even though women face similar risks later in life.

The underlying cause of this early vulnerability lies in how risk factors like hypertension, high cholesterol, and LDL cholesterol escalate over time. “In men, the atherosclerotic process progresses steadily, creating a perfect storm for heart disease as they age,” explains Dr. Nair.

Hormones play a significant role in the gender disparity seen in heart disease. “Estrogen offers women some protection before menopause by supporting blood vessel health and regulating cholesterol levels,” says Dr. Nair.

Men, however, lack this hormonal safeguard. Testosterone, the primary male hormone, has a more complex relationship with heart health. While it supports various bodily functions, its levels begin to decline after age 40. “This drop in testosterone has been linked to higher risks of cardiovascular disease and overall mortality,” Dr. Nair adds.

The situation is particularly concerning for South Asian men, who are at a much higher risk of heart disease compared to their Western counterparts. Studies reveal that South Asians experience acute myocardial infarction (AMI) 5–10 years earlier, with men facing these heart attacks an average of 5.6 years earlier than women.

“The risk factors for South Asians are both genetic and lifestyle-driven,” says Dr. Nair. “Key contributors include abnormal lipid profiles, smoking, diabetes, abdominal obesity, and psychosocial stress.” These factors collectively account for 86 per cent of AMI cases in South Asians.

Unlike Western populations, regular alcohol consumption does not provide cardiovascular protection for South Asians. “This highlights the importance of culturally tailored health interventions,” Dr. Nair emphasizes.

Chronic stress is another major player in heart health. While both men and women experience stress, Dr. Nair explains that the ways they process it differ. “Men are more likely to externalize stress, often through aggression or harmful coping mechanisms like smoking and excessive alcohol consumption. These behaviours significantly elevate their cardiovascular risk.”

Anatomical Differences and Disease Presentation

Anatomical variations between genders also influence heart disease outcomes. Men typically have larger hearts and blood vessels than women. “In men, cholesterol tends to accumulate in the major arteries, leading to more noticeable blockages and events like heart attacks,” explains Dr. Nair. In contrast, women are more prone to cholesterol buildup in smaller blood vessels, which can cause microvascular disease—a condition that is often underdiagnosed.

Proactive prevention remains key in combating heart disease in men. Dr. Nair recommends the following measures:

1. Regular Health Screenings: “Monitoring blood pressure, cholesterol, and blood sugar levels should start in your 30s or even earlier if there’s a family history of heart disease.”

2. Healthy Lifestyle Changes: “A diet rich in fruits, vegetables, and whole grains, combined with regular physical activity, can go a long way in reducing risk.”

3. Stress Management: “Mindfulness, meditation, or simply taking time to unwind can make a significant difference.”

4. Medical Consultations: “Discuss your testosterone levels and overall heart health with a doctor, especially as you age.”

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