There are substantial gender differences in the pattern, severity and clinical outcomes of
coronary heart disease independent of environmental risk factor exposure. As a consequence, there has been considerable interest in the potential role of
sex hormones in
atherogenesis, particularly the potential protective effects of oestrogen. However, the failure of the recent clinical randomised trials to show a cardioprotective effect for oestrogen coupled with a growing interest in
androgen replacement
therapy in elderly men has refocused interest on the role of
androgens in cardiovascular biology and disease. Over the last decade, compelling evidence has emerged that sex differences in vascular biology are not only determined by gender-related differences in sex
steroid levels but also by gender-specific tissue and cellular characteristics which mediate sex-specific responses to a variety of stimuli. In the vasculature,
androgens often act in a gender-specific manner, with differential effects in male and female cells. This gender-dependent regulation may have important implications for understanding the basis of the gender gap in
atherosclerosis and may eventually lead to the development of sex-specific treatments for
cardiovascular disease. This review will summarise the current data for the role of
androgens in gender differences in
coronary heart disease and cardiovascular biology.