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Different physiological mechanisms underlie an adverse cardiovascular disease risk profile in men and women.

Authors
  • Fappi, Alan1
  • Mittendorfer, Bettina1
  • 1 Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO, USA.
Type
Published Article
Journal
Proceedings of The Nutrition Society
Publisher
Cambridge University Press
Publication Date
May 01, 2020
Volume
79
Issue
2
Pages
210–218
Identifiers
DOI: 10.1017/S0029665119001022
PMID: 31340878
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

CVD affect about one-third of the population and are the leading cause of mortality. The prevalence of CVD is closely linked to the prevalence of obesity because obesity is commonly associated with metabolic abnormalities that are important risk factors for CVD, including insulin resistance, pre-diabetes, and type-2 diabetes, atherosclerotic dyslipidaemia, endothelial dysfunction and hypertension. Women have a more beneficial traditional CVD risk profile (lower fasting plasma glucose, less atherogenic lipid profile) and a lower absolute risk for CVD than men. However, the relative risk for CVD associated with hyperglycaemia and dyslipidaemia is several-fold higher in women than in men. The reasons for the sex differences in CVD risk associated with metabolic abnormalities are unclear but could be related to differences in the mechanisms that cause hyperglycaemia and dyslipidaemia in men and women, which could influence the pathogenic processes involved in CVD. In the present paper, we review the influence of a person's sex on key aspects of metabolism involved in the cardiometabolic disease process, including insulin action on endogenous glucose production, tissue glucose disposal, and adipose tissue lipolysis, insulin secretion and insulin plasma clearance, postprandial glucose, fatty acid, and triglyceride kinetics, hepatic lipid metabolism and myocardial substrate use. We conclude that there are marked differences in many aspects of metabolism in men and women that are not all attributable to differences in the sex hormone milieu. The mechanisms responsible for these differences and the clinical implications of these observations are unclear and require further investigation.

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