Cardiovascular disease (CVD) is still the leading cause of death worldwide. In 2013, 32% of deaths in men and 35% of deaths in women were due to CVD. Despite the higher percentage of CVD deaths in women, CVD is still widely considered as a man’s disease. This assumption stems from the historical misperception that the manifestation of CVD among women is uncommon or is not characterised by the same symptoms as it is in men.

Men generally develop CVD at a younger age and have a higher propensity of developing coronary heart disease (CHD) than women. Women, in contrast, are at a higher risk of stroke, which often occurs at older age.  Hence, stroke and CHD mortality rates in middle-aged men are typically higher than in middle-aged women, a difference that may persist throughout most of the lifetime. Successes in primary and secondary strategies have led to major reductions in age-standardised CVD mortality rates, especially in Western countries where case fatality rates have dropped significantly and where access to prevention and healthcare is typically higher than in other parts of the world. At present, however, it remains unknown to what extent the reductions in age-standardised CVD mortality rates have affected the sex difference in CHD and stroke mortality rates, standardised by age and across the life course.   Nor has there been a comprehensive assessment of as to what extent such changes in sex differences differ across geographically diverse regions.

It is evident that older people are at a higher risk of dying from CHD and stroke than younger people. Often researchers opine that women ‘catch up’ with men after the menopause, but whether this is true in this context is debated.10 Furthermore, it is unknown whether the effect of ageing, in both sexes, is the same now as it was 20–30 years ago, while a comprehensive analysis of the effects of ageing on the relative chances of dying from CHD and stroke is lacking.