Sex Hormones and Cardiometabolic Risk

Cardiometabolic diseases are the leading cause of disability and death worldwide and a major public health concern. Serum levels and actions of sex hormones, in particular androgens and estrogens differ between men and women and have been indicated as important determinants of sex differences in cardiometabolic diseases. In this thesis we performed original data analyses and systematic reviews and meta-analyses to investigate the associations between endogenous and exogenous sex hormones and phytoestrogens (plant derived estrogen-like compounds) and various cardiometabolic outcomes. We showed that androgen imbalance may be as important as estrogen variations in regard of cardiometabolic risk in aging women. Higher serum estradiol can mark the increased risk of stroke in women but not in men with carotid atherosclerosis and its utility as a biomarker in predicting risk stroke should be further explored. We have summarized the existing evidence on contraceptive and hormone therapy use and cardiovascular risk. Based on findings from more than 2.5 million postmenopausal women, we present a clinical guideline on hormone therapy use, indicate the knowledge gaps and give implications for future research. Also, we shed more light on progestin-only contraceptive use in regard of cardiometabolic outcomes. Furthermore, we indicated that phytoestrogen dietary intake improves glucose homeostasis and may prevent type 2 diabetes in women, while not having an impact on body composition. These findings contribute to improve our understanding of the role of sex hormones in the pathophysiology of cardiometabolic diseases