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Sex differences in cardiometabolic disorders

Nature Medicine volume 25, pages 1657–1666 (2019)Cite this article

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Abstract

The prevalence of cardiometabolic disorders in both women and men has increased worldwide and is linked to a rise in obesity and obesity-associated associated clustering of other cardiometabolic risk factors such as hypertension, impaired glucose regulation and dyslipidemia. However, the predominance of common types of cardiometabolic disorders such as heart failure, atrial fibrillation and ischemic heart disease is sex specific, and our identification of these and the underlying mechanisms is only just emerging. New evidence suggests that sex hormones, sex-specific molecular mechanisms and gender influence glucose and lipid metabolisms, as well as cardiac energy metabolism, and function. Here we review sex differences in cardiometabolic risk factors, associated preclinical and clinical cardiac disorders and potential therapeutic avenues.

Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge1,2,3. Obesity is associated with clustering of other cardiometabolic risk factors, such as hypertension, impaired glucose regulation and dyslipidemia, which contribute to the obesity-associated damage of the heart and arteries. Several meta-analyses have demonstrated the equivalence of blood pressure, cholesterol and body mass index (BMI) in contributing to the relative risk of coronary heart disease and stroke in women and men4,5,6, while diabetes mellitus confers a higher risk in women7. Yet the impact of these risk factors on preclinical cardiac disease and other common cardiometabolic disorders, such as heart failure and atrial fibrillation, differs by sex8,9. Stronger consideration should be given to understanding these sex differences and how to integrate them into therapeutic approaches. Thus, the current review gives an update on sex differences in cardiometabolic risk factors and associated preclinical and clinical cardiac disorders, focusing on the diverse diagnostic findings and clinical implications in women and men.

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Fig. 1: Characteristics of preclinical and clinical cardiometabolic disorders in women and men.
Fig. 2: Sex-specific features in cardiometabolic disorders.

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Authors and Affiliations

  1. Department of Clinical Science, University of Bergen, Bergen, Norway

    Eva Gerdts

  2. Berlin Institute for Gender in Medicine, Charité Universitätsmedizin, Berlin, Germany

    Vera Regitz-Zagrosek

  3. DZHK, partner site Berlin, Berlin, Germany

    Vera Regitz-Zagrosek

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  1. Eva Gerdts
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  2. Vera Regitz-Zagrosek
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E.G. and V.R-Z. both drafted and contributed to the manuscript and approved the final version.

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Correspondence to Eva Gerdts.

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Gerdts, E., Regitz-Zagrosek, V. Sex differences in cardiometabolic disorders. Nat Med 25, 1657–1666 (2019). https://doi.org/10.1038/s41591-019-0643-8

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