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Obesity, Body Composition, and Sex Hormones: Implications for Cardiovascular Risk

Prachi Singh, Naima Covassin, Kara Marlatt, Kishore M. Gadde, Steven B. Heymsfield

10.1002/cphy.c210014

Source: Volume 12, Issue 1, January 2022

Published online: December 2021

Full Article on Wiley Online Library



Abstract

Cardiovascular disease (CVD) continues to be the leading cause of death in adults, highlighting the need to develop novel strategies to mitigate cardiovascular risk. The advancing obesity epidemic is now threatening the gains in CVD risk reduction brought about by contemporary pharmaceutical and surgical interventions. There are sex differences in the development and outcomes of CVD; premenopausal women have significantly lower CVD risk than men of the same age, but women lose this advantage as they transition to menopause, an observation suggesting potential role of sex hormones in determining CVD risk. Clear differences in obesity and regional fat distribution among men and women also exist. While men have relatively high fat in the abdominal area, women tend to distribute a larger proportion of their fat in the lower body. Considering that regional body fat distribution is an important CVD risk factor, differences in how men and women store their body fat may partly contribute to sex‐based alterations in CVD risk as well. This article presents findings related to the role of obesity and sex hormones in determining CVD risk. Evidence for the role of sex hormones in determining body composition in men and women is also presented. Lastly, the clinical potential for using sex hormones to alter body composition and reduce CVD risk is outlined. © 2022 American Physiological Society. Compr Physiol 12:1‐45, 2022.

Figure 1. Figure 1. Schematic highlighting the differential body composition and fat distribution in men and women along with its contribution towards CVD risk. Changes in body fat distribution in postmenopausal women are emphasized. Arrows indicate prevalence of body composition variables in obese women and men. Downward arrows indicate low prevalence and upward arrows indicate high prevalence. Green‐colored text and arrows indicate cardioprotective effects and red‐colored text and arrows indicate detrimental cardiovascular effects.
Figure 2. Figure 2. Simplified schematic highlighting pathways involved in synthesis of sex hormones. Cholesterol is a precursor for progestins which are converted to androgens and mineral corticoids through enzymatic processes in specific cell types. Estrogen production relies on aromatization of androgens.


Figure 1. Schematic highlighting the differential body composition and fat distribution in men and women along with its contribution towards CVD risk. Changes in body fat distribution in postmenopausal women are emphasized. Arrows indicate prevalence of body composition variables in obese women and men. Downward arrows indicate low prevalence and upward arrows indicate high prevalence. Green‐colored text and arrows indicate cardioprotective effects and red‐colored text and arrows indicate detrimental cardiovascular effects.


Figure 2. Simplified schematic highlighting pathways involved in synthesis of sex hormones. Cholesterol is a precursor for progestins which are converted to androgens and mineral corticoids through enzymatic processes in specific cell types. Estrogen production relies on aromatization of androgens.
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Article Title: Obesity, Body Composition, and Sex Hormones: Implications for Cardiovascular Risk
 

How to Cite

Prachi Singh, Naima Covassin, Kara Marlatt, Kishore M. Gadde, Steven B. Heymsfield. Obesity, Body Composition, and Sex Hormones: Implications for Cardiovascular Risk. Compr Physiol 2021, 12: 2949-2993. doi: 10.1002/cphy.c210014