Figure 1.

(A) Factors impacting the gut microbiome in a sex-specific manner. The depicted factors can lead to marked differences between men and women in the intestinal microbial community. (B) The gut microbiome and the cardiovascular system. Dietary and other factors impact the gut microbiome, which, in turn, influences cardiovascular health. In disease, drugs elicit responses in the gut microbiome, which, in turn, influences the progression of cardiovascular disease. (C) Interrelationships between biological sex, gut microbiota and the cardiovascular system. We propose the cardiovascular-gut microbiome-sex axis, where the cross-talk between gut microbiota and sex impacts cardiovascular health and disease. Gonadal sex gives rise to male-female hormones and impacts the gut microbiome. In turn, there is a close, bi-directional interaction between sex hormones and gut microbiota, as they influence each other, thereby leading to sex-biased disease susceptibility and severity, ultimately leading to the observed sex differences in cardiovascular disease.