Way to a man's heart disease is filled with social expectation

SALT LAKE CITY — More people die of or are sickened by cardiovascular disease than any other cause, although the risk of illness and death can be changed or prevented, compared to many other diseases. The key is finding it early.

And that's the rub.

Finding out you have risk factors like hypertension or high cholesterol is important, but it happens well below the levels that health experts call optimal. Public health experts estimate as many as three-fourths of young adults who have such risk factors don't know it.

And men and boys who embrace "stereotypical gender norms" are at the forefront of not recognizing or being treated for risk factors associated with heart disease.

That's according to a new study led by University of Chicago researchers just published in JAMA Network Open, part of the Journal of the American Medical Association network. In a news release, the researchers said the findings "build on existing research that sociocultural pressures to perform male gender identity are linked to detrimental health-related behaviors such as substance use and rejection of medical therapies and recommendations."

That males are less likely to seek help for a lot of conditions, but especially mental health and primary care, is well-known, said Dr. Nathaniel Glasser, general internist and pediatrician at the University of Chicago medical school, who was the study's lead author. "But previous studies haven't probed further into the social processes through which male gender is iteratively created through an interplay between the individual and the surroundings." He added, "We used innovative measurement techniques to look at the construction of male gender and how it's associated with cardiovascular disease prevention."

About the study

The researchers took data from nationally representative Add Health, a long-term study that included 12,300 people at multiple points over the course of 24 years (1994-2018). To quantify male gender expression, they looked at a subset of survey questions with answers that were notably different between male and female participants, measuring how closely the male participants' answers matched those of their male peers.

Glasser emphasized that it was about gender expression, not anything "physiologic that could be affected by the Y chromosome. We purely focused on self-reported behaviors," to see how well the reported attitudes and behaviors match those of the other males, he said in study background material.

The focus was, of course, cardiovascular disease: Researchers compared the Add Health data with health survey responses and found men with more stereotypical gender expression were significantly likely to report a health care professional had ever said they had cardiovascular-related risks. If they had been diagnosed, they were still less likely to report taking medication to treat the condition.

The risk factors examined are those routinely found in primary care. But the study didn't show if the decrease in diagnosis and treatment in this population was due to not getting screened, not paying attention to disease-related findings when they get them or "downplaying" it.

"Our hypothesis is that social pressures are leading to behavioral differences that impact cardiovascular risk mitigation efforts, which is concerning because it could be leading to worse long-term health consequences," Glasser said.

The researchers believe the implications reach "far beyond the topic of traditional masculinity," per the release.

"We're seeing how pressures to convey identity — whether it's rooted in gender, race, sexuality or something else — impact health behaviors," Glasser said. "Fitting in and achieving belonging is a complicated task and we feel strongly that increased societal sympathy, empathy and patience for those undertaking that task would be good for people's health."

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