Why middle-aged men are sitting on a heart health time bomb

Men tend to be ‘doctor-averse’ and ignore heart health risks – so an emphasis is on early diagnosis and treatment is key

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In the days since DJ Steve Wright’s sudden death, conversation about men’s health has flourished on the airwaves. We do not know for sure how Wright died, but according to a friend, the 69-year old had undergone a heart bypass surgery 15 months earlier and was “more ill than he let on”. 
Others spoke of his fondness for cigars and takeaways: recent images showed the DJ to be significantly overweight – factors known to contribute to heart disease. “The normal stuff – diet, nutrition, exercise, sleep, stress,” said Wright’s brother Laurence, earlier this week. “It’s like anyone who doesn’t look after themselves over an extended period.”
Coronary heart disease is the number one cause of death for both sexes in the industrialised world. However, according to Ruth Goss, a senior cardiac nurse for the British Heart Foundation: “Coronary heart disease affects twice as many men as women and is the main source of heart attacks.”
The source for this oft-quoted statistic is a Norwegian study of 34,000 people who had a heart attack between 1979 and 2012. Researchers found that throughout their lives, the men were about twice as likely as women to suffer this serious outcome.
“That higher risk persisted even after they accounted for traditional risk factors for heart disease, including high cholesterol, high blood pressure, diabetes, body mass index, and physical activity,” said the study.
There are other contributing factors. According to a 2022 paper from the drug company Merck, men undergo far fewer preventive check-ups than women, 43 per cent compared to 61 per cent. Separate research a year earlier polled men for their doctor-averse behaviour. 
One in three said they were “too busy” to see their GP, 28 per cent were worried about burdening the NHS, 26 per cent “unable to get an appointment around work hours “, and 23 per cent claimed “embarrassment or awkwardness”. On cardiac matters specifically, a 2019 Lancet study revealed men worldwide to be less aware of their high blood pressure scores than women.
In 2017 Public Health England revealed that “one in 10 men aged 50” have a heart age 10 years older than they are. But is this just down to a weakness for steaks and a few afternoons in the pub?
Len Drane was 42 and managing director of a childcare company when he had a heart attack out of the blue in April 2004. “I was on the 3rd hole of the golf course when I started feeling sweaty, with crushing pain in my chest and my jaw,” says the now-62-year-old from South Wales.
“By the fifth, I could no longer go on.” Fortunately, he was accompanied by a friend with army medical experience, and they rushed to hospital.
The doctors at first thought Drane was suffering with angina, but it was later he’d confirmed he’d had a heart attack. He underwent surgery to insert three stents fitted into his arteries – his blood vessels had narrowed and he needed the small mesh tubes to keep them open. 
“As a man with three young children, I was shocked,” he says. “I played rugby regularly and thought I was reasonably fit. But I had smoked earlier in my life, and at 5”7 was 17 and a half stone. I wasn’t a particularly heavy drinker, but I did enjoy pasties and pies.”
Tests revealed that Drane had very high cholesterol  – inherited from both his parents, and two years later, he discovered he was type-2 diabetic. And though he was put on statins for the former and has recently started taking insulin for the latter, in common with other men at risk of heart conditions, Drane was told he was going to have to modify his lifestyle.
Research shows that men are particularly at risk of factors that raise heart risk. A 2016 report published in JAMA Internal Medicine “revealed gender differences in psychosocial and behavioural coronary risk factors, including excessive alcohol consumption and smoking, favouring women.
“Overall, it appears that men’s coping with stressful events may be less adaptive physiologically, behaviourally, and emotionally, contributing to their increased risk for coronary heart disease.”
Drane accepts that stress may have contributed to his ill-health: he scaled back his work commitments, finally retiring two years ago. “I set about changing my life in a quiet way, rather than doing it all at once, which could have set me up for failure,” he says.
Over the next few years, Drane lost four-and-a-half stone. “I started going to light circuit training at my local fitness centre, especially people in rehab from heart problems,” he says. “Everyone else there was in their 60s and 70s – it was a bit surreal.”
Drake consulted a dietician, cutting back on the pasties and making simple switches. “I swapped fried rice to boiled rice and started eating more fish,” he says.
Enlisting his wife, Jayne, was also important to his recovery. “She was really supportive,” he says. “Even though I’m 62 now, she’s still a mother hen. Both of us are involved in setting my health goals.”
Other friends of his have not been so lucky. “I’ve had a few mates who have died of heart attacks and strokes,” he says. “They tended to be single men who have hit the bottle and whose lifestyle was not the best.”
Friends of the DJ Steve Wright noted that his solitary lifestyle may have contributed to his death; Wright and his American wife Cyndi Robinson divorced in 1999, but he was said to be heartbroken at her death during the pandemic almost four years ago.
The historic trope of a heart attack does tend to involve a middle-aged, overweight man clutching his chest, but there’s a growing evolution in how the medical profession looks at heart disease. 
Amitava Banerjee is Professor in Clinical Data Science and Honorary Consultant Cardiologist, UCL and Barts Health and a spokesman for the British Cardiovascular Society “The historical data do suggest that men are more likely to have more cardiovascular disease factors,” he says.
“But this may be partly because men presented earlier and with more classic symptoms, such as central chest pain, compared with women. Therefore they may be diagnosed more. In fact, I have spent much of my professional life insisting we need to recognise that heart disease is not just a male disease.”
Many agree that women’s heart disease increasingly requires more attention precisely because it’s not seen as “a women’s problem” – and women’s symptoms can be different from the classical male ones. Women are more likely to suffer nausea, for example.
According to Banerjee, risk factors for heart disease are common to both men and women. “Everyone has heard of high cholesterol and high blood pressure – these are the risk factors we should be looking out for,” he says. He is also concerned about the rise of Type 2 diabetes and obesity across an ageing population.
“These are preventable with lifestyle interventions and can be treated with medication,” says Banerjee. “The emphasis is on early diagnosis and early treatment.”
Len Drane discovered his heart problems under dramatic circumstances, but intervention with both lifestyle changes and medication ensure he lives a full and active life, gardening in his new greenhouse, spending time with his grandchildren and travelling with Jayne. He even enjoys a glass of wine occasionally. 
“After my heart attack, it would have been easy to get depressed,” he says. “I initially felt isolated, but soon realised I wasn’t on my own. I asked my lovely consultant: what can I do? His advice to me was: “you know your limitations. Go on with your life. Try everything.”
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