Sex Differences in the Metabolic Syndrome: Implications for Cardiovascular Health in Women

BACKGROUND: The metabolic syndrome is a clinical condition characterized by the presence of multiple in-terrelated risk factors for type 2 diabetes and cardiovas-cular disease. Component features include dysglyce-mia, increased blood pressure, increased triglycerides, decreasedHDL cholesterol concentrations, and obesity (in particular, abdominal obesity). The underlying bi-ology, optimal diagnostic criteria, and clinical implica-tions, once diagnosed, have been matter for intense debate. Despite these areas of controversy, there is now general consensus that the observed risk factor cluster-ing signifies heightened cardiovascular risk. CONTENT: The influence of sex on the clinical expres-sion and pathophysiology of the syndrome is underrec-ognized, and is an issue of increasing importance given the alarming increase in prevalence among young women. This minireview will highlight sex differences in the epidemiology, etiology, biology, and clinical ex-pression of the metabolic syndrome. In particular, key sex differences include distinctions in (a) prevalence of dysglycemia, (b) body fat distribution, (c) adipocyte size and function, (d) hormonal regulation of body weight and adiposity, and (e) the influence of estrogen decline on risk factor clustering. SUMMARY: Accumulated and emerging data convincingly demonstrate that significant heterogeneity exists between men and women developing the metabolic syndrome, in large part related to hormonal regulation of body fat dis-tribution and attendant metabolic abnormalities