TY - JOUR
T1 - Different physiological mechanisms underlie an adverse cardiovascular disease risk profile in men and women
AU - Fappi, Alan
AU - Mittendorfer, Bettina
N1 - Funding Information:
The authors received salary support from NIH grants DK115400, DK121560, DK56341 (Washington University School of Medicine Nutrition and Obesity Research Center), and UL1 TR000448 (Washington University School of Medicine Clinical Translational Science Award), a grant from the American Diabetes Association (ICTS 1-18-ICTS-119) and the Atkins Obesity Award while working on this manuscript.
Publisher Copyright:
© The Authors 2019.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - 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.
AB - 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.
KW - Diabetes
KW - Dyslipidaemia
KW - Insulin resistance
KW - Metabolic syndrome
UR - http://www.scopus.com/inward/record.url?scp=85069736320&partnerID=8YFLogxK
U2 - 10.1017/S0029665119001022
DO - 10.1017/S0029665119001022
M3 - Article
C2 - 31340878
AN - SCOPUS:85069736320
SN - 0029-6651
VL - 79
SP - 210
EP - 218
JO - Proceedings of the Nutrition Society
JF - Proceedings of the Nutrition Society
IS - 2
ER -