Since the late 1980s, the prevalence of coronary artery disease and myocardial infarction (MI) has declined in middle-aged men, but increased among middle-aged women. These worrisome findings have been reported by Amytis Towfighi and colleagues from California, USA.

Historically, premenopausal women were thought to be at lower cardiovascular risk than men of a similar age. However, evidence that stroke prevalence among middle-aged women was almost double that of their male contemporaries challenged this thinking. “Given the similar underlying causes for heart disease and stroke, we hypothesized that perhaps women's prevalence of heart disease had also increased in recent years” says Towfighi.

Using data from the US National Health and Nutrition Examination Surveys (NHANES), which was conducted in phases (1988–1994 and 1999–2004), the researchers found that there was a trend toward increasing prevalence of MI among women aged 35–54 years over the past two decades. Although the prevalence of MI remained higher in men than in women overall, the rate of MI had declined in men between 1988 and 2004. These data indicate that the difference in cardiovascular risk between the sexes is less than it was 20 years ago. In addition, men showed an improvement in Framingham risk score between the two phases of NHANES, whereas the score had worsened in women. “This study should add further impetus to control vascular risk factors in both men and women in their midlife years” suggests Towfighi.