Dr. Jincy Thankachen Gashi, DO
Men and Heart Disease
As we recognize Men's Health Month, it is important to raise awareness about heart disease, the leading cause of death among men, with one in four male deaths attributed from it, according to the Centers for Disease Control and Prevention (CDC) (1). A recent study shows that men develop a greater risk of cardiovascular disease years earlier than women, starting around the age 35, making this a critical point to initiate positive lifestyle and behavior modifications (2).
Heart disease can present in many ways, with the most common being coronary artery disease. This can progress to a heart attack (chest pain with activity, including sexual activity) or to heart failure (shortness of breath and fluid overload in the lungs and body/legs) or even abnormal electrical rhythms leading to heart failure and/or sudden cardiac death.
Why are men at risk?
Men face several unique risk factors for heart disease. Unlike women, they do not benefit from the protective effects of estrogen and progesterone, which help support blood vessel health. Instead, men rely primarily on testosterone, which naturally declines after age 40 and may contribute to increased cardiovascular risk (2). Cholesterol buildup in the arteries remains one of the leading causes of heart disease, and excess abdominal fat, which is more common in men, is strongly associated with cardiovascular disease, sleep apnea, abnormal heart rhythms, and heart failure.
Lifestyle factors also play a significant role. While both men and women experience chronic stress, men may be more likely to externalize stress through anger or aggression. Research has shown that the risk of a heart attack can increase significantly in the hours following an angry outburst. Men also have higher rates of high blood pressure, alcohol consumption, and smoking, all of which contribute to cardiovascular disease.
When combined with physical inactivity, obesity, and genetic predisposition, these factors can lead to metabolic syndrome (MetS), a cluster of conditions that promotes insulin resistance, chronic inflammation, and hormonal changes that accelerate heart disease. Low testosterone levels are also commonly seen in individuals with metabolic syndrome and have been linked to poorer cardiovascular outcomes (3,4). Perhaps most concerning, heart failure, once considered primarily a disease of older adults, is increasingly being diagnosed in people under age 65, particularly among Hispanic and Black populations (5).
What can men do?
Men are often less likely to see physicians regularly or undergo annual screenings. Many say since they feel fine, they don’t need to see a physician. However, it is important to realize our bodies do not give us ample early warning signs of a serious health event. Think of cancer. Cancer cells are growing in the body years before people realize something is wrong. Heart disease is similar. We often also ignore symptoms or attribute it to something else. In fact, some men experience what is known as “vital exhaustion,” an overwhelming sense of fatigue that may precede a cardiac event (8).
Regular exercise, stress management, and a healthy diet are key to reducing cardiovascular risk. Simple habits such as walking, taking the stairs, practicing mindfulness or meditation, and eating a balanced diet rich in vegetables, lean proteins, and complex carbohydrates can improve overall health and lower blood pressure.
While lifestyle changes are the foundation of prevention, they are not always enough. Aging, genetics, and other factors can increase risk despite healthy habits. In these cases, medications to manage blood pressure, cholesterol, or weight may be necessary to help prevent serious health events. Working with your physician can help determine the best approach for maintaining long-term heart health.
Leading with Purpose and Compassion
I have spent my career serving the NYC Health + Hospitals/Jacobi community. As Director of Heart Failure, I am proud to care for a diverse and often underserved patient population whose resilience and dedication to their families inspire me every day. As the daughter of immigrant parents from India who came to the United States with very little and worked tirelessly to create opportunities for their children, I feel fortunate for the path I have been given and am committed to helping my patients achieve healthier, fuller lives. As a heart failure and transplant physician, I have helped patients recover from advanced heart disease and advocated for access to life-saving therapies, including heart transplantation and mechanical circulatory support. What drives me most is the opportunity to make a meaningful difference alongside colleagues who share the same commitment to serving others. Balancing a demanding career with being a wife and mother of two is not always easy, but I tell myself everyday – just show up, do your best. When you do, you will be successful in the areas that matter most – serving others and living with integrity.
Jincy Thankachen, M.D., MSc
Director of Heart Failure, NYC Health + Hospitals/Jacobi
Attending, Advanced Heart Failure and Transplant, Montefiore Medical Center, Bronx NY
Assistant Professor of Medicine, Albert Einstein College of Medicine
References:
1. https://www.cdc.gov/heart-disease/about/men-and-heart-disease.html
2. Alexa A. Freedman, Laura A. Colangelo and Hongyan Ning et al. Sex Differences in Age of Onset of Premature Cardiovascular Disease and Subtypes: The Coronary Artery Risk Development in Young Adults Study. J Am Heart Assoc. 2026. Vol. 15(3). DOI: 10.1161/JAHA.125.044922
4. Goodale T, Sadhu A, Petak S, Robbins R. Testosterone and the Heart. Methodist Debakey Cardiovasc J. 2017 Apr-Jun;13(2):68-72. doi: 10.14797/mdcj-13-2-68. PMID: 28740585; PMCID: PMC5512682
5. Ingelsson E, Arnlöv J, Lind L, Sundström J. Metabolic syndrome and risk for heart failure in middle-aged men. Heart. 2006 Oct;92(10):1409-13. doi: 10.1136/hrt.2006.089011. Epub 2006 May 22. PMID: 16717067; PMCID: PMC1861065.
6. Purwowiyoto SL, Prawara AS. Metabolic syndrome and heart failure: mechanism and management. Med Pharm Rep. 2021 Jan;94(1):15-21. doi: 10.15386/mpr-1884. Epub 2021 Jan 29. PMID: 33629043; PMCID: PMC7880077.
7. https://medicine.yale.edu/news-article/heart-failure-young-adults/
8. Cohen R, Bavishi C, Haider S, Thankachen J, Rozanski A. Meta-Analysis of Relation of Vital Exhaustion to Cardiovascular Disease Events. Am J Cardiol. 2017 Apr 15;119(8):1211-1216. doi: 10.1016/j.amjcard.2017.01.009. Epub 2017 Jan 25. PMID: 28215416.