Plasma fructose explains sex differences in multiple cardiovascular risk factors

To investigate sex differences in cardiovascular disease (CVD) risk and to identify if plasma fructose associates with isolated cardiovascular risk factors and estimated CVD risk.

This is a cross-sectional study which included 597 adults aged 20-79 years, using baseline data collected between 2014 and 2018. Demographic and clinical data were assessed, while food consumption was investigated by a food frequency questionnaire. Fasting plasma fructose, glucose, lipid biomarkers and hepatic inflammatory enzymes were analyzed, as well as hepatic steatosis by ultrasound. The overall CVD risk was estimated using the American College of Cardiology/American Heart Association (ACC/AHA) equation. Associations between fructose and isolated biomarkers and predicted CVD risk were tested using multivariable linear and logistic regressions in both crude and adjusted models.

Men exhibited more cardiovascular risk factors than women, including higher plasma fructose concentrations (63.63 ± 27.07 vs. 55.30 ± 20.67 mg/dL; p < 0.001), independent of dietary fructose intake (p ≥ 0.05). Men with higher plasma fructose concentrations showed significant associations in adjusted models with excess weight, high waist circumference, dyslipidemia (high total cholesterol, low high-density lipoprotein cholesterol - HDL-c, high non-HDL-c, high triglycerides) and altered glycemia. These associations reflected a worse assessment of cardiovascular risk scores, with higher estimated CVD risk associated with high fructose (β = 0.07; 95 % CI = 0.04-0.09; p < 0.001). Sex-specific differences were observed in association between plasma fructose concentrations and CVD risk, with a stronger relationship identified in men (β = 0.11; 95 % CI = 0.07-0.16; p < 0.001).

Plasma fructose is negatively associated with multiple isolated CVD risk factors and CVD risk estimate. This relationship was particularly robust in men.