The findings, based on more than 30 years of follow-up data, suggest that heart disease screening and prevention efforts may need to begin earlier in adulthood, particularly for men.

“That timing may seem early, but heart disease develops over decades, with early markers detectable in young adulthood,” said senior author Alexa Freedman, assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine. “Screening at an earlier age can help identify risk factors sooner and enable preventive strategies that reduce long-term risk.”

While earlier research has consistently shown that men tend to experience heart disease sooner than women, risk factors such as smoking, high blood pressure and diabetes have become increasingly similar between the sexes over recent decades. Despite this convergence, the gap in disease onset has not narrowed — a finding researchers described as unexpected.

To better understand why these differences persist, Freedman and her colleagues say future research should examine not only traditional risk factors like cholesterol and blood pressure, but also broader biological and social influences.

The study is set to be published January 28 in the Journal of the American Heart Association.