NCPA - National Center for Policy Analysis

Why Do More Men Die from Heart Disease than Women?

September 7, 2001

In most industrialized countries more men die from coronary heart disease than women. The most widely accepted explanation is that the difference in mortality rates is due to a protective effect of the female hormone estrogen.

However, a new study in the British Medical Journal suggests that sex differences in coronary heart disease are largely the result of environmental factors. If so, it may be possible to reduce deaths in men to levels similar to those found in women.

Using several national and international data sources, researchers at Bristol University examined trends in deaths from coronary heart disease in men and women from different countries.

  • From 1949, in England and Wales, these trends show a marked increase of deaths among men, peaking in the early 1970s.
  • Rates in women over the same period were stable or declined.
  • And similar trends were seen in Australia, France, Sweden and the United States.

A protective effect of estrogen alone cannot explain these trends because levels of estrogen in women have not changed dramatically over the past century, nor do estrogen levels vary greatly among women of different countries, say the authors.

Instead, the authors conclude, differences in heart disease are largely the result of environmental factors that affect only men. This suggests that lifestyle or environmental changes could reduce men's heart disease rates to comparable levels with women.

However, the study did not determine what those factors are. Indeed, the researchers found that a mean (average) increase in men's fat consumption was positively correlated with coronary disease mortality -- but women's fat consumption was inversely correlated.

Source: D. A. Lawlor, S. Ebrahim and G. Davey Smith, "Sex matters: secular and geographical trends in sex differences in coronary heart disease mortality," British Medical Journal, September 8, 2001.

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