Why do women live longer than men? Biologic differences that influence longevity.

Women enjoy a natural relative immunity to coronary atherosclerosis compared with their male counterparts because of their sex hormone status, especially in the premenopausal years. This advantage is likely to be extended to the postmenopausal years by the current widespread prescription of estrogen (coupled with cyclic progestin) therapy. Currently available forms of exogenous estrogen preparations do not confer similar benefits on men, nor would their feminizing side effects be acceptable to men. Therefore, to narrow the sex differential in longevity, with its devastating burdens of loneliness and dependency on elderly women and monetary and time burdens on healthcare resources, men must adopt behaviors that reduce their risk of coronary artery disease. Such behaviors are cessation of cigarette smoking, early detection and long-term control of hypertension, and early detection and long-term control of dyslipoproteinemia (as best reflected in the ratio of low-density lipoprotein to high-density lipoprotein cholesterol). Fortunately, the recent advent of effective dietary and, especially, drug therapy for both hypertension and dyslipoproteinemia makes such approaches to reducing male cardiovascular mortality feasible, effective, and of acceptable cost in both economic and personal terms.