Men and Heart Disease: Take Lifestyle Cues from Women

He says he doesn't want to "start another gender war," but Byung-il William (Bill) Choi, MD, a cardiologist and Professor of Medicine at the Medical College of Wisconsin, says men could learn a lot from women about preventing heart disease.

Last year, 930,000 Americans died from heart disease, making it the No.1 or No. 2 killer of both men and women in the United States. But thousands more men die from heart disease every year than women, and they die at an earlier age. According to the Department of Health and Human Services (HHS), men are 30% more likely to suffer a stroke than are women, making it the third-leading cause of death in men. Both heart disease and stroke are cardiovascular diseases, or diseases of the blood vessels. One in three men can expect to develop some major cardiovascular disease before the age of 60, HHS says.

"Not all the risk factors for heart disease can be changed," Dr. Choi says. "Some are hereditary. But others stem from lifestyle choices, and here's where men could learn a lot from women."

Diet: Although a majority of both men and women in the United States are now classified as overweight, and many are obese, there's emerging evidence that Americans are beginning to alter their diets to improve their health. Women seem more likely than men to adapt to these changes by eating fewer saturated fats and carbohydrates, and including more fiber from fruits, vegetables and whole grains, Dr. Choi says.

"It's a cultural issue," he believes. "A man's idea of a good meal is a bloody steak, not a wimpy salad or fish. It goes back to when we lived in the forest, and men were the hunters and gatherers of meat. They got the first portion before they'd share it with their family. For centuries, women have been the starved species, eating the leftovers. That's probably why women have been smaller than men. There was some justification for men's eating such hearty portions when they did hard physical labor in the fields and factories, but not today, when most men work seated at a desk all day. That steak that men like is high in saturated fat, and it can clog the arteries over time."

And men tend to skip breakfast more than women. That's not a good idea, Dr. Choi says, because it encourages them to eat a big lunch and dinner, often filled with high-cholesterol foods.

Exercise: Living a sedentary lifestyle can be harmful to good health. Women seem more receptive to adding exercise to their lives, Dr. Choi thinks. They do most of the housework, which can burn calories, and they seem more willing to take walks than men do. Many men who do work out in a gym often focus on weight building rather than aerobic activities. "Their models are typically sports figures with big muscles."

Following Doctor's Orders: Men avoid doctor visits far more than women, lest they appear weak or out of control. Thus, they often neglect getting recommended routine screening tests for blood sugar and cholesterol that can indicate increased heart disease risks. "Women visit doctors more, and they tend to be more compliant and willing to follow their doctors' orders. They are more caregivers for their children and themselves, inscribed in their DNA," he says.

Hot Tempers: Men seem more prone to flying into a rage or venting their tempers than women do. "That's not a good thing," says Dr. Choi. "Emotional outbursts can increase blood pressure, heart rate and adrenalin levels. It may have worked when we lived in the forest, and you had to raise your voice to alert the herd. It's barbaric behavior today. Men need to learn to modulate their behavior, channel their emotions and convert their tempers to compassion."

(One long-term study at Johns Hopkins university of more than 1,000 young male medical school students and physicians found that young men with quick tempers and hostile feelings were significantly more likely than their less angry colleagues to have a heart attack or other cardiovascular disease before 55 years of age. Results were reported in the April 22, 2002, edition of the Archives of Internal Medicine.)

Smoking: One risk factor where women are not setting an example for men is smoking, however. Although fewer women smoke than men, the percentage difference between the two continues to decrease every year.

Cigarette smoking increases the risk of coronary heart disease by increasing blood pressure, decreasing ability to exercise, and increasing the tendency for blood to clot. Smoking also increases LDL (bad) cholesterol and decreases HDL (good) cholesterol. Not only does smoking cause lung diseases such as lung cancer, emphysema and chronic bronchitis, it can increase the risk for other health problems, including stroke, impotence and infertility, and cancer of the throat, mouth, esophagus, pancreas, kidney, bladder and prostate. "Men who smoke have more embolic strokes than women," Dr. Choi says. An embolic stroke occurs when a blood clot travels from the heart or elsewhere in the body to the neck or brain and blocks a blood vessel.

Why Are Men at Greater Risk?
Men develop risks for heart disease (including stroke) and suffer heart attacks at a younger age than women do. In men, the risk of having a heart attack increases after age 45; in women, the risks increase after 55.

For years, it was widely believed that the reason for the later onset of heart disease in women was that estrogen, the hormone women produce during their childbearing years, provides protection.

Although women's risks for heart disease do rise rapidly when estrogen production declines after menopause, it might not explain the difference, Dr. Choi says. "It's a hypothesis," he says. The large Women's Health Initiative study found that post-menopausal women taking estrogen replacement therapy actually showed slight increases of heart disease and breast cancer.

Some scientists, in fact, have speculated that women's lower rate of heart disease may actually be the norm, and men's rate is accelerated for some reason.

Statistics for men are improving, however. In 1990, the death rate for men from heart disease was twice that of women. That gap has closed in the past 15 years. Right now, however, men of all ages still have heart disease at a higher rate than women do.

Dr. Choi's prescription for men: "Starting in their youth, men should listen to their mothers and wives, and strive for a good family life."

And for women, this warning: "If women continue to drink, smoke and fight like men, the gender advantage of heart disease in women would not only diminish, but also bring disaster to mankind.

"It would be a healthy society if we used wisdom from women and courage from men for good causes," he says.

Barbara Abel
HealthLink Contributing Writer

This article includes information from the US Department of Health and Human Services.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.