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Gender-Specific Associations Between Sex Hormones and Cardiovascular Disease: A Systematic Review and Meta-Analysis
Wenting Wang1, Lulu Zhu1, Miaomiao Qi1
1Department of Cardiology, Lanzhou University Second Hospital, 730030 Lanzhou, Gansu, China.
Reviews in Cardiovascular Medicine
|June 4, 2026
Summary
Sex hormones impact cardiovascular disease (CVD) risk differently in men and women. Higher testosterone benefits men, while it increases risk for women, highlighting the need for sex-specific CVD prevention strategies.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Public Health
Background:
- Sex hormones significantly influence cardiovascular disease (CVD) development.
- Existing evidence on sex hormone associations with cardiovascular outcomes is inconclusive and varies by sex.
Purpose of the Study:
- To systematically review and meta-analyze prospective cohort studies on sex hormones and cardiovascular outcomes.
- To investigate sex-specific associations between circulating sex hormones and CVD risk.
Main Methods:
- Systematic review and meta-analysis of 23 prospective cohort studies.
- Extracted hazard ratios (HRs) and 95% confidence intervals (CIs).
- Performed subgroup analyses by hormone type, age, and sex.
Main Results:
- In men, higher total testosterone (TT) linked to reduced CVD risk.
- In women, elevated TT and calculated free testosterone (cFT) associated with increased CVD risk.
- Dehydroepiandrosterone (DHEA) linked to higher heart failure risk; estradiol showed mixed effects.
Conclusions:
- Sex hormones have complex, sex-specific, and outcome-dependent effects on cardiovascular risk.
- Findings emphasize integrating sex, age, and endocrine status in CVD risk assessment.
- Tailored prevention strategies considering hormonal profiles are crucial for cardiovascular health.
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