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Table 1 Sexual dimorphism in four main cardiovascular disease risk factors

From: Sex, gut microbiome, and cardiovascular disease risk

CVD risk factor Men Women Evidence/potential mechanisms
Impaired glucose regulationA Incidence of impaired fasting glucose
Incidence of diabetes at earlier ages
Insulin sensitivity
Incidence of impaired glucose tolerance
Incidence of diabetes
Insulin sensitivity
Estrogens may confer a protective effect on insulin-glucose homeostasis [172,173,174,175,176,177,178]:
- Reduction in inflammation, reactive oxygen species, hepatic glucose production, and central and visceral adiposity.
- Improves glucose uptake by skeletal muscle via activation of PPAR-γ.
Testosterone appears to exhibit a U-shaped association with insulin resistance [179,180,181,182,183]:
- Excess testosterone in both sexes is associated with dysglycemia and inhibits myocyte, adipocyte insulin in women.
- Testosterone associates with reduced visceral and central adiposity, as well as decreased waist-to-hip ratio in men.
DyslipidemiaB HDL-C
Total plasma TG
FFA oxidation at rest
Total plasma TG
FFA storage at rest
Sexual dimorphism is observed in lipid profiles of premenopausal women compared to men [184,185,186,187]
HypertensionC Younger ages [118, 188,189,190]
↑ Systolic BP
↑ Incident hypertension
↓ Salt sensitivity
Older ages
↓ Incident hypertension
All ages
↑ Diastolic BP
↓ Survival with hypertension
Younger ages
↓ Systolic BP
↓ Incident hypertension
↑ Salt sensitivity
Older ages (postmenopausal)
↑ Incident hypertension
All ages
↓ Diastolic BP
↑ Survival with hypertension
Endogenous estrogen has a BP lowering effect [118, 191,192,193,194].
- Possible mechanisms include RAAS and endothelin system, oxidative stress, nitric oxide production, and salt sensitivity.
Androgens (testosterone) have pro-hypertensive properties.
- Possible mechanisms include blunting of the pressure-natriuresis relationship, RAAS, and oxidative stress.
ObesityD ↓ Obesity [195]
↑ Lean tissue; ↓ Total fat
↑ Visceral adipose tissue
↑ Obesity [195]
↓ Lean tissue; ↑ Total fat
↑ Subcutaneous adipose tissue
Estrogen and androgens impact energy utilization, storage, and fat distribution [196,197,198,199].
  1. ABroad category of prediabetic syndromes, including impaired fasting glucose (WHO criteria, > 110 mg/dL; ADA criteria, > 100 mg/dL) as well as impaired glucose tolerance, a condition in which a given concentration of insulin, endogenous or exogenous, is accompanied by an inadequate glucose response
  2. BAn elevation in circulating total cholesterol, low-density lipoprotein, high-density lipoprotein, and/or triglycerides
  3. CDefined by ACC/AHA 2017 guidelines: systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥  80 mmHg
  4. DDefined by a body mass index ≥ 30 kg/m2
  5. BP blood pressure, FFA free fatty acids, HDL-C high-density lipoprotein cholesterol, LDL-C low-density lipoprotein cholesterol, PPAR-γ peroxisome proliferator-activator gamma, RAAS renin-angiotensin-aldosterone system, VLDL-C very low-density lipoprotein cholesterol