Middle-aged men with high cholesterol levels are at greater risk for a first heart attack than similar women are, Norwegian researchers report.
In a study of more than 40 000 men and women under the age of 60, men with high cholesterol had more than three times the risk of having a heart attack, compared to women with high cholesterol.
"In middle age, our results suggest that high cholesterol is much more detrimental for men than for women, and that prevention and treatment of high cholesterol in middle-aged men have a great potential to reduce the occurrence of heart attacks among men," said lead researcher Dr Erik Madssen, from the department of circulation and medical imaging at the Norwegian University of Science and Technology, in Trondheim.
Men under 60 should be diagnosed and treated for high cholesterol more aggressively than what often is the case today, he added.
To reduce the risk of heart attack, men should be counselled about making lifestyle changes, such as diet and exercise, as well as taking medication such as statins like Lipitor, to lower their cholesterol levels. "This is especially true in males that have a family history of heart attacks and in smokers," Madssen said.
Why there is this difference in risk between men and women isn't clear, but Madssen thinks it may have to do with the protective effects of hormones like oestrogen, which is why they limited their study to women and men under 60.
"We believe that females below 60 years of age may be protected against some of the cardiovascular consequences of having high cholesterol due to female sex hormones such as oestrogen," he said.
The report was published in the September issue of Epidemiology.
Protection with statins
One expert said it is important for both men and women to keep their cholesterol in check.
"It is well established [that] men have a higher risk for heart attacks at an earlier age than women, with an approximately 10-year risk differential, but over a lifetime the cardiovascular risk in women exceeds that of men," said Dr Gregg Fonarow, spokesman for the American Heart Association and a professor of cardiology at the University of California, Los Angeles.
In addition, it has been shown that higher cholesterol levels are an independent risk factor for men and women, with both sexes deriving similar benefits in terms of protection from cardiovascular disease with statins, he added.
"The use of lifestyle modification and statin therapy is one of the most effective, cost-effective and high-value therapeutic approaches to prevent cardiovascular events and prolong life in men as well as women," Fonarow said. "Attention to cholesterol levels and other risk factors remain vital for both men and women."
For the study, Madssen's team collected data on 23 525 women and 20 725 men who were younger than 60 when they took part in the second Nord-Trondelag Health Study. In that survey, which was done in 1995-1997 across Norway, participants had blood samples taken and analyzed.
Over 12 years of follow-up, 522 men had a first heart attack, compared with 157 women.
The researchers also looked at heart attacks among 20 138 people aged 60 and older at the time of the survey. However, among these participants there was no gender difference in the risk for heart attacks, they noted.
For more on cholesterol, visit the American Heart Association.