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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
↑ LDL-C
↑ VLDL
↑ Total plasma TG
↑ FFA oxidation at rest 		↑ HDL-C
↓ LDL-C
↓ VLDL
↓ 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
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Biology of Sex Differences

ISSN: 2042-6410

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