Gender issues in heart disease for aging men

Abstract

Gender-specific issues relating to prevention of heart disease are new and exciting areas for research. It is well established that cardiovascular disease in men is more common than in women, except perhaps in the postmenopausal stage. Estrogens seem to protect women from heart disease in the premenopausal stage. Although androgens might influence cardiovascular risks, its overall effects are uncertain because many interacting factors need to be considered. The synthesis of testosterone in men suppresses hepatic production of apolipoprotein A (apo A), the precursor of the HDL particle. This leads to a 20% reduction in HDL in men compared with women. This difference persists through adulthood and is now thought to explain part of the gender difference in early heart disease. The effect of androgens on the aging process seems however to be positive rather than negative. Cardiovascular risk factors can be reversed with life-style changes in both men and women. Smoking is more common in men than women and is the most preventable risk factor but still more than a quarter of men smoke. Hypertension too is slightly more common in men, affecting one in four men in adult life. Although men are more likely than women to be physically active, 30 to 50% are sedentary. Obesity in men has a centripetal distribution and affects risks for heart disease differently than in women. Finally cardiovascular symptoms can change, especially with aging. All these points will be discussed in this article.