VII.19. Age and sex

The risk of CVD increases with age. After 65 years of age, the risk is twofold. In old age, the insulin sensitivity decreases and the structure of the circulatory system changes (stiffer vessel walls).  

The development of atherosclerotic lesions usually starts in childhood or adolescence.  In the post-mortem examinations of persons under 20 years of age, fatty stripes were found in 20% of the vessel walls. In those 2-15 years of age fatty stripes were found in the coronaries in every other person. In those 21-39 years of age, fatty stripes were found in 85%. In the same age groups, plaques had developed in 8%, whereas in the elderly generation it was 69%. 

Coronary sclerosis is more frequent among men than among women, but in cases of T2DM there is no difference. After the menopause, the difference disappears.

On the above basis, it was demonstrated that androgens increase the vasoconstriction sensitivity of the vessels and the level of insulin resistance. Increased androgen production (hyperandrogenism) enhances insulin resistance. Insulin resistance and visceral obesity decrease the testosterone level. An increased free estrogen level enhances the insulin response to the OGTT. The estrogen level rises in DM patients. During physical activity, the estrogen/testosterone ratio decreases.

The difference between the genders can be explained by the difference in testosterone sensitivity.