Understanding the Role of Sex Hormones in Cardiovascular Kidney Metabolic Syndrome: Toward Personalized Therapeutic Approaches

Guldan M. Unlu S. Abdel-Rahman S.M. Ozbek L. Gaipov A. Covic A. Soler M.J. Covic A. Kanbay M.
August 2024 Multidisciplinary Digital Publishing Institute (MDPI)

Journal of Clinical Medicine
2024 #13 Issue 15

Cardiovascular kidney metabolic (CKM) syndrome represents a complex interplay of cardiovascular disease (CVD), chronic kidney disease (CKD), and metabolic comorbidities, posing a significant public health challenge. Gender exerts a critical influence on CKM syndrome, affecting the disease severity and onset through intricate interactions involving sex hormones and key physiological pathways such as the renin–angiotensin system, oxidative stress, inflammation, vascular disease and insulin resistance. It is widely known that beyond the contribution of traditional risk factors, men and women exhibit significant differences in CKM syndrome and its components, with distinct patterns observed in premenopausal women and postmenopausal women compared to men. Despite women generally experiencing a lower incidence of CVD, their outcomes following cardiovascular events are often worse compared to men. The disparities also extend to the treatment approaches for kidney failure, with a higher prevalence of dialysis among men despite women exhibiting higher rates of CKD. The impact of endogenous sex hormones, the correlations between CKM and its components, as well as the long-term effects of treatment modalities using sex hormones, including hormone replacement therapies and gender-affirming therapies, have drawn attention to this topic. Current research on CKM syndrome is hindered by the scarcity of large-scale studies and insufficient integration of gender-specific considerations into treatment strategies. The underlying mechanisms driving the gender disparities in the pathogenesis of CKM syndrome, including the roles of estrogen, progesterone and testosterone derivatives, remain poorly understood, thus limiting their application in personalized therapeutic interventions. This review synthesizes existing knowledge to clarify the intricate relationship between sex hormones, gender disparities, and the progression of CVD within CKM syndrome. By addressing these knowledge gaps, this study aims to guide future research efforts and promote tailored approaches for effectively managing CKD syndrome.

cardiovascular kidney metabolic syndrome , chronic kidney disease , diabetes mellitus , metabolic syndrome , sex hormone

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Department of Medicine, Koç University School of Medicine, Istanbul, 34450, Turkey
Department of Medicine, School of Medicine, Nazarbayev University, Astana, 010000, Kazakhstan
Department of Nephrology, Grigore T, Popa University of Medicine, Iasi, 700115, Romania
Nephrology Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute of Research, Barcelona, 08035, Spain
Centro de Referencia en Enfermedad, Glomerular Compleja del Sistema Nacional de Salud de España (CSUR), RICORS2040 (Kidney Disease), Barcelona, 08003, Spain
GEENDIAB (Grupo Español de Estudio de la Nefropatía Diabética), Santander, 39008, Spain
Division of Nephrology, Department of Medicine, Koç University School of Medicine, Istanbul, 34450, Turkey

Department of Medicine
Department of Medicine
Department of Nephrology
Nephrology Department
Centro de Referencia en Enfermedad
GEENDIAB (Grupo Español de Estudio de la Nefropatía Diabética)
Division of Nephrology

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