Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO, USA.
Proc Nutr Soc. 2020 May;79(2):210-218. doi: 10.1017/S0029665119001022. Epub 2019 Jul 25.
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.
CVD 影响约三分之一的人口，是导致死亡的主要原因。CVD 的患病率与肥胖症的患病率密切相关，因为肥胖症通常与代谢异常有关，而代谢异常是 CVD 的重要危险因素，包括胰岛素抵抗、前驱糖尿病和 2 型糖尿病、动脉粥样硬化性血脂异常、内皮功能障碍和高血压。与男性相比，女性具有更有利的传统 CVD 风险特征（空腹血糖较低，致动脉粥样硬化的血脂谱较少），且 CVD 的绝对风险较低。然而，与高血糖和血脂异常相关的 CVD 风险在女性中的相对风险是男性的数倍。与代谢异常相关的 CVD 风险的性别差异的原因尚不清楚，但可能与导致男性和女性高血糖和血脂异常的机制差异有关，这可能会影响 CVD 相关的致病过程。在本文中，我们回顾了个体性别对涉及心血管代谢疾病过程的代谢关键方面的影响，包括胰岛素对内源性葡萄糖生成、组织葡萄糖摄取和脂肪组织脂肪分解、胰岛素分泌和胰岛素血浆清除、餐后血糖、脂肪酸和甘油三酯动力学、肝脂质代谢和心肌底物利用的影响。我们得出结论，男性和女性在许多代谢方面存在显著差异，这些差异并非全部归因于性激素环境的差异。这些差异的机制以及这些观察结果的临床意义尚不清楚，需要进一步研究。
