Gender aspects of the role of the metabolic syndrome as a risk factor for cardiovascular disease.

BACKGROUND

The interaction of the risk factors of abdominal obesity, disturbed glucose homeostasis, dyslipidemia, and hypertension is believed to represent a distinct entity, termed the metabolic syndrome (MetS), that leads to a greater increase in cardiovascular risk than does the sum of its components.

OBJECTIVE

We reviewed currently available information regarding gender differences in the role of the MetS as a risk factor for cardiovascular disease (CVD).

METHODS

Using the search terms women, men, sex, gender, sex differences, and gender differences in combination with the metabolic syndrome, we conducted a systematic review of the available literature on sex differences in the MetS. The National Institutes of Health, PubMed, and MEDLINE databases were searched retrospectively from 2007 to 1987. Reference lists of identified articles were also used as a source, and articles were not restricted to the English language.

RESULTS

In recent years, the MetS has been more prevalent in men than in women but has risen particularly in young women, where it is mainly driven by obesity. Diagnostic criteria for the MetS vary for the cutoff points and definition of its components in a gender-specific manner. Based on the definition of impaired glucose homeostasis and pathologic abdominal circumference or waist/hip ratio, more or fewer women are included. Glucose and lipid metabolism are directly modulated by estrogen and testosterone, with a lack of estrogen or a relative increase in testosterone inducing insulin resistance and a proatherogenic lipid profile. Hypertension is a strong risk factor in both sexes, but the prevalence of hypertension increases more rapidly in aging women than in men. Menopause and polycystic ovary syndrome contribute to the development of MetS by the direct effects of sex hormones. Some components of the MetS (eg, diabetes and hypertension) carry a greater risk for CVD in women.

CONCLUSIONS

Future gender-related clinical and research activities should focus on the identification of sex- and gender-specific criteria for risk management in patients with the MetS. We propose small, focused, mechanistic studies on sex-specific surrogate end points and sex-specific studies in animal models for diabetes and aging.