OBJECTIVE: To investigate the association of sex hormones at baseline and 1 year after a lifestyle intervention on cardiovascular (CV) risk in type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: This prospective study, following the Look AHEAD: Action for Health in Diabetes (Look AHEAD) trial, of 2,260 adults with T2D, included measurements of sex hormones and sex hormone binding globulin (SHBG). Baseline levels and 1-year changes were divided into sex-specific tertiles to assess the association with CV events (n = 488 events) and weight loss interactions. RESULTS: In men, higher baseline total testosterone was associated with lower CV risk (hazard ratio [HR] = 0.74; 95% CI 0.56–0.97). In men with ≥7% weight loss, SHBG increases were inversely associated with CV risk (HR = 0.47; 95% CI 0.26–0.85). In men with <7% weight loss, increases in estradiol were associated with CV risk (second vs. first estradiol tertile: HR = 1.64 [95% CI 1.13–2.38]; third vs. first estradiol tertile: HR = 1.88 [95% CI 1.29–2.73]). No associations were detected in women. CONCLUSIONS: In men with T2D, but not women with T2D, sex hormones were associated with CV events.

Our aim is to investigate if sex and gender influence the association of hypertension and their comorbidities. We investigated how gender differences in five socioeconomic factors impact the relation between hypertension and ten comorbidities including diabetes mellitus, renal disease, and chronic pulmonary disease in European countries grouped by their gender inequality index using representative survey data from the European Health Interview Survey. Using logistic regressions, we compute the ratio of odds ratios in females versus males. Therefore, an ORR > 1 is associated with a higher odds ratio for females than for males while an ORR < 1 means the opposite. To account for multiple hypothesis testing, we applied the Bonferroni correction. Hypertension in both sexes was associated with lower educational level, being unemployed, and lower income. In males, being divorced/widowed (OR1.12, p < 0.001) had an association to hypertension, whereas in females, being common-law/married (OR1.30, p < 0.001) and being divorced/widowed (OR1.17, p < 0.001) was associated with a higher risk for hypertension. Moreover, in hypertension, females who worked had an association with myocardial infarction (OR1.39, p < 0.001) and having post-secondary education had an association with arthrosis (OR 1.35, p < 0.001) compared to males. Our findings show that gender variables influence the association of hypertension and comorbidities, especially in females. These results can be used to inform targeted prevention measures taking gender-specific contextual factors into account.

Objectives: We aimed to assess sex differences in benefits from cardiac rehabilitation and the impact of comorbidities. Methods: We analyzed 3239 individuals with cardiovascular diseases (81.2% males) who participated in a three-week cardiac rehabilitation program at Bad Schallerbach center (Upper Austria). Training success was measured by maximal oxygen consumption (VO₂ max). Sex-specific differences in baseline characteristics were assessed using t-tests/chi² tests. Associations between covariates and the outcome were evaluated with baseline-adjusted univariate analysis of variance/linear regression models. Covariates significant at α = 0.05 were included in a multivariable linear regression model, which was refined by backward selection based on the best Akaike information criterion. The final model was used to test the relationship between sex and the outcome. Results: The mean age and BMI were 63.9 years and 27.5 kg/m² for males and 67.2 years and 27.4 kg/m² for females. Males had higher baseline VO₂ max compared to females (26.18 mL/min/kg vs. 23.55 mL/min/kg, p < 0.001), and a greater change in VO₂ max after rehabilitation was seen in males compared to females (3.64 mL/min/kg vs. 2.77 mL/min/kg, p < 0.001). Female sex was associated with a 1.4-point-lower change in VO₂ max after adjustment for comorbidities, sex, and training intensity (β coefficients = −1.409; CI 95% −0.410, −0.104; p < 0.001). Heart valve surgery (β coefficients = −0.90; CI 95% −1.444, −0.366; p < 0.001) and diabetes mellitus (β coefficients = −1.207; CI 95% −1.926, −0.488; p < 0.0001) were associated with lower changes in VO₂ max in both sexes. Conclusions: Our findings suggest that females and individuals with specific comorbidities benefit less from cardiac rehabilitation and support the creation of personalized rehabilitation programs.

Purpose: Our aim was to untangle the effect of biological sex and psychosocial gender on rates of self‐reported cancer. Methods: For this study, the Austrian Health Information Survey 2019 was used. Individuals with cancer ( n = 415) were selected and divided by sex (female 53.3%). Descriptive results were reported as mean/standard deviation or frequency/percentage. Next, the cancer versus non‐cancer and female versus male cancer cohorts were compared by using a chi‐square test or an unpaired t ‐test. By logistic regression models adjusted by age, the association of cancer, biological sex, and gender‐related variables (including employment status, educational level, marital status, household income and size) was investigated in the total cohort, as well as stratified by sex. Results: Self‐reported cancer was positively related with being unemployed/retired versus employed (OR 2.06, p < 0.001), being married versus single (OR 1.90, p = 0.005), household size over 1 compared to 1 (OR 1.42, p = 0.025), self‐reported depression (OR 2.13, p < 0.001), and former smoking (OR 1.84, p < 0.001). A negative relation between having cancer and being a daily smoker was seen (OR 0.22, p = 0.006). No association between cancer and biological sex was found. Similar correlations of gender‐related variables on cancer rates were found in the sex‐disaggregated analyses; however, marital status as well as daily smoking were not associated with cancer diagnosis in males. In contrast to males, in females former smoking and alcohol consumption showed no association with cancer rates. Conclusion: Our findings suggest that gender‐related variables, rather than biological sex, are associated with sel‐reported cancer.

Background: Obesity in pregnancy is linked to adverse clinical outcomes such as gestational diabetes. Recently, a risk score calculated by different ceramide concentrations was recognized as a new way to investigate cardiovascular risk. The aim was to analyze if the ceramide risk score and cardiometabolic risk vary between normal-weight, obese, and females with prior Roux-en-Y bypass surgery (RYGB) during pregnancy. Methods: Three cohorts were investigated: first, 25 pregnant females with a history of RYGB; second, 19 with preconception BMI ≥ 35 kg/m²; and third, 19 normal-weight (preconception BMI < 25 kg/m²). Around the 24th to 28th weeks of gestation routine laboratory assessments, 3 h 75 g oral and intravenous glucose tolerance tests were carried out. The correlation of ceramide risk scores and ceramide ratios (Cer(d18:1/18:0)/Cer(d18:1/16:0)) with metabolic parameters was analyzed via Pearson correlation. The cohorts were compared via ANOVA and unpaired t-tests. Results: The RYGB cohort had lower ceramide risk scores and ratios compared to obese pregnant females (7.42 vs. 9.34, p = 0.025; 0.33 vs. 0.47, p < 0.001). Ceramide risk score and ratio were found to correlate negatively with insulin sensitivity (measured with the Matsuda (r = −0.376, p = 0.031; r = −0.455, p = 0.008) and calculated sensitivity index (r = −0.358, p = 0.044; r = −0.621, p < 0.001) in females without RYGB. The ceramide risk score correlated positively with body fat in RYGB females (r = 0.650, p = 0.012). Conclusions: We found that females after RYGB have lower ceramide risk scores and ceramide ratios compared to obese pregnant females, possibly indicating lower metabolic risk.

Background: We investigated immunization status and preventive care among diabetes mellitus (DM) patients by stratifying them into clinically distinct risk clusters based on comorbidities, reflecting a personalized medicine approach. Methods: Using the Austrian health interview survey 2019, we identified four groups: cluster 1 (DM, arterial hypertension (aHTN), dyslipidemia; n = 215), cluster 2 (DM, aHTN, dyslipidemia, obesity class II; n = 33), cluster 3 (DM, aHTN, dyslipidemia, depression; n = 65), and a control cohort (DM without hyperlipidemia, hypertension, depression, or obesity class II; n = 214). The cohorts were compared by chi² tests. By logistic regression the association of the cluster-related variables and the vaccination status/preventive care variables were analyzed. Results: Significant differences in intact diphtheria immunization between the cohorts exist (cluster 1: 45.6%, cluster 2: 27.3%, cluster 3: 52.3%, control: 51.9%, p-value 0.047). Differences in intact tetanus (42.4% vs. 64%, p = 0.027) and diphtheria (27.3% vs. 51.9%, p = 0.013) immunization between cluster 2 and control cohort were investigated. Cluster 2 was negatively associated with tetanus (OR 0.83, p = 0.009) and diphtheria (OR 0.85, p = 0.018) immunization. Cluster 1 reports higher rates of fecal occult blood test (50.7% vs. 39.3%, p = 0.022) and cluster 2 reports a higher rate of colonoscopy (24.2% vs. 8.9%, p = 0.015) in comparison to the control cohort. Conclusions: A personalized medicine approach reveals that DM patients with specific comorbidity patterns, particularly those with hypertension, dyslipidemia, and obesity class II, have lower immunization rates—highlighting the need for targeted preventive strategies.