Basal metabolic rate and cardiovascular diseases in women: mechanistic insights and clinical implications

Xueqian Huang , Jingwen Li , Ziling Huang , Yixin Wang , Dan-Qing Yu , Xu-Yu He

Vessel Plus ›› 2025, Vol. 9 ›› Issue (1) : 30

PDF
Vessel Plus ›› 2025, Vol. 9 ›› Issue (1) :30 DOI: 10.20517/2574-1209.2025.94
Review

Basal metabolic rate and cardiovascular diseases in women: mechanistic insights and clinical implications

Author information +
History +
PDF

Abstract

Cardiovascular diseases (CVDs) pose a significant threat to global public health and are the leading cause of death in women. Basal metabolic rate (BMR), which reflects the minimum energy expenditure required to maintain essential physiological functions at rest, has emerged as a crucial indicator of energy metabolism and a potential predictor of disease risk and health status. This review comprehensively examines the role of BMR in women’s CVDs, exploring its associations with body composition, thyroid function, mitochondrial efficiency, and the autonomic nervous system. It also delves into how BMR influences CVD risk across different physiological stages in women, including the reproductive years, pregnancy, and menopausal transition. Furthermore, this review proposes a diagnostic and therapeutic framework centered on BMR, encompassing precise assessment, pharmacological interventions, lifestyle modifications, and the application of emerging technologies. The aim is to enhance women’s cardiovascular health and reduce premature mortality.

Keywords

Basal metabolic rate / cardiovascular disease / female

Cite this article

Download citation ▾
Xueqian Huang, Jingwen Li, Ziling Huang, Yixin Wang, Dan-Qing Yu, Xu-Yu He. Basal metabolic rate and cardiovascular diseases in women: mechanistic insights and clinical implications. Vessel Plus, 2025, 9(1): 30 DOI:10.20517/2574-1209.2025.94

登录浏览全文

4963

注册一个新账户 忘记密码

References

[1]

Roth GA, Mensah GA, Johnson CO, et al.; GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study.J Am Coll Cardiol2020;76:2982-3021

[2]

Roth GA,Abajobir A.Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015.J Am Coll Cardiol2017;70:1-25

[3]

Vogel B,Appelman Y.The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030.Lancet2021;397:2385-438

[4]

Yusuf S, Hawken S, Ounpuu S, et al.; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study.Lancet2004;364:937-52

[5]

Ko SH.Menopause-associated lipid metabolic disorders and foods beneficial for postmenopausal women.Nutrients2020;12:202 PMCID:PMC7019719

[6]

Bozkurt B, Aguilar D, Deswal A, et al.; American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular and Stroke Nursing; Council on Hypertension; and Council on Quality and Outcomes Research. Contributory risk and management of comorbidities of hypertension, obesity, diabetes mellitus, hyperlipidemia, and metabolic syndrome in chronic heart failure: a scientific statement from the American Heart Association.Circulation2016;134:e535-78

[7]

Mulder CL,Grieger JA.Cardio-metabolic risk factors among young infertile women: a systematic review and meta-analysis.BJOG2020;127:930-9

[8]

Handelsman Y,Bakris GL.DCRM 2.0: multispecialty practice recommendations for the management of diabetes, cardiorenal, and metabolic diseases.Metabolism2024;159:155931

[9]

Gerdts E.Sex differences in cardiometabolic disorders.Nat Med2019;25:1657-66

[10]

Xu Y.Association of insulin resistance and elevated androgen levels with polycystic ovarian syndrome (PCOS): a review of literature.J Healthc Eng2022;2022:9240569 PMCID:PMC8959968

[11]

Tadic M,Vasic D.Cardiovascular implications of diabetes, metabolic syndrome, thyroid disease, and cardio-oncology in women. In: Kerkhof PLM, Miller VM, editors. Sex-specific analysis of cardiovascular function. Cham: Springer International Publishing; 2018. pp. 471-88.

[12]

Henry CJ.Basal metabolic rate studies in humans: measurement and development of new equations.Public Health Nutr2005;8:1133-52

[13]

Levine JA.Measurement of energy expenditure.Public Health Nutr2005;8:1123-32

[14]

Shetty P.Energy requirements of adults.Public Health Nutr2005;8:994-1009

[15]

Maciak S,Sadowska A.Low basal metabolic rate as a risk factor for development of insulin resistance and type 2 diabetes.BMJ Open Diabetes Res Care2020;8:e001381 PMCID:PMC7373309

[16]

Piaggi P,Bogardus C.Lower energy expenditure predicts long-term increases in weight and fat mass.J Clin Endocrinol Metab2013;98:E703-7 PMCID:PMC3615206

[17]

Ruggiero C,Melenovsky V.High basal metabolic rate is a risk factor for mortality: the Baltimore Longitudinal Study of Aging.J Gerontol A Biol Sci Med Sci2008;63:698-706 PMCID:PMC4984846

[18]

Fabbri E,Schrack JA.Energy metabolism and the burden of multimorbidity in older adults: results from the Baltimore Longitudinal Study of Aging.J Gerontol A Biol Sci Med Sci2015;70:1297-303 PMCID:PMC4612383

[19]

Zampino M,Kuo PL,Ferrucci L.Longitudinal changes in resting metabolic rates with aging are accelerated by diseases.Nutrients2020;12:3061 PMCID:PMC7600750

[20]

Ventura-Clapier R,Garnier A,Lemaire C.Gender issues in cardiovascular diseases. Focus on energy metabolism.Biochim Biophys Acta Mol Basis Dis2020;1866:165722

[21]

Ward LJ,Hammar M.Resistance training decreases plasma levels of adipokines in postmenopausal women.Sci Rep2020;10:19837 PMCID:PMC7669850

[22]

Chistiakov DA,Melnichenko AA,Orekhov AN.The role of mitochondrial dysfunction in cardiovascular disease: a brief review.Ann Med2018;50:121-7

[23]

Riley M,McKane WR,Stanford CF.Resting energy expenditure in chronic cardiac failure.Clin Sci1991;80:633-9

[24]

Poehlman ET,Gottlieb SS,Vaitekevicius P.Increased resting metabolic rate in patients with congestive heart failure.Ann Intern Med1994;121:860-2

[25]

Zhao P,Liang X.Causal effects of basal metabolic rate on cardiovascular disease: a bidirectional Mendelian randomization study.J Am Heart Assoc2024;13:e031447

[26]

Chen K,Zhou S,Xiang M.The association between the basal metabolic rate and cardiovascular disease: a two-sample Mendelian randomization study.Eur J Clin Invest2024;54:e14153

[27]

Li Y,Kang L,Zhao X.Causal association between basal metabolic rate and risk of cardiovascular diseases: a univariable and multivariable Mendelian randomization study.Sci Rep2023;13:12487 PMCID:PMC10393961

[28]

Alcantara JMA,Plaza-Florido A.Associations between intra-assessment resting metabolic rate variability and health-related factors.Metabolites2022;12:1218 PMCID:PMC9781460

[29]

Alcantara JMA,Castillo MJ,Amaro-Gahete FJ.Intra-assessment resting metabolic rate variability is associated with cardiometabolic risk factors in middle-aged adults.J Clin Med2023;12:7321 PMCID:PMC10707389

[30]

Ali N,Manirujjaman M.Hypertension prevalence and influence of basal metabolic rate on blood pressure among adult students in Bangladesh.BMC Public Health2017;18:58 PMCID:PMC5526296

[31]

Kim GH,Archer SL.The role of redox signaling in epigenetics and cardiovascular disease.Antioxid Redox Signal2013;18:1920-36 PMCID:PMC3624767

[32]

Miller VM.Vascular actions of estrogens: functional implications.Pharmacol Rev2008;60:210-41 PMCID:PMC2637768

[33]

Qiu Y,Zeng Y.Advances in mitochondrial dysfunction and its role in cardiovascular diseases.Cells2025;14:1621 PMCID:PMC12563985

[34]

Sun N,Finkel T.The mitochondrial basis of aging.Mol Cell2016;61:654-66 PMCID:PMC4779179

[35]

Li J,Song S.Mitochondria spatially and temporally modulate VSMC phenotypes via interacting with cytoskeleton in cardiovascular diseases.Redox Biol2023;64:102778 PMCID:PMC10277590

[36]

Kararigas G,Forler S.Comparative proteomic analysis reveals sex and estrogen receptor β effects in the pressure overloaded heart.J Proteome Res2014;13:5829-36

[37]

Mason FE,Alhussini K,Voigt N.Cellular and mitochondrial mechanisms of atrial fibrillation.Basic Res Cardiol2020;115:72 PMCID:PMC7704501

[38]

Kang KW.Mechanistic insights into heart failure induction in ovariectomized rats: the role of mitochondrial dysfunction.Medicine2025;104:e43709 PMCID:PMC12338167

[39]

Pavón N,Hernández L.Sexual hormones: effects on cardiac and mitochondrial activity after ischemia-reperfusion in adult rats. Gender difference.J Steroid Biochem Mol Biol2012;132:135-46

[40]

Uribe-Alvarez C,Morales-García L.Estrogen degradation metabolites: some effects on heart mitochondria.J Xenobiot2025;15:170 PMCID:PMC12565399

[41]

Peterson LR,Herrero P.Impact of gender on the myocardial metabolic response to obesity.JACC Cardiovasc Imaging2008;1:424-33 PMCID:PMC2982260

[42]

Goveia J,Carmeliet P.Principles of targeting endothelial cell metabolism to treat angiogenesis and endothelial cell dysfunction in disease.EMBO Mol Med2014;6:1105-20 PMCID:PMC4197858

[43]

Wilson C,Buckley C,McCarron JG.Mitochondrial ATP production is required for endothelial cell control of vascular tone.Function2023;4:zqac063 PMCID:PMC9909368

[44]

Rutkai I,Katakam PV.Dynamics of enhanced mitochondrial respiration in female compared with male rat cerebral arteries.Am J Physiol Heart Circ Physiol2015;309:H1490-500 PMCID:PMC4666975

[45]

Li XT,Tian T.The UCP2/PINK1/LC3b-mediated mitophagy is involved in the protection of NRG1 against myocardial ischemia/reperfusion injury.Redox Biol2025;80:103511 PMCID:PMC11808529

[46]

Wu H,Liu D.UCP2 protect the heart from myocardial ischemia/reperfusion injury via induction of mitochondrial autophagy.J Cell Biochem2019;120:15455-66

[47]

Zheng Z,Wang X.Integrative analysis of genes provides insights into the molecular and immune characteristics of mitochondria-related genes in atherosclerosis.Genomics2025;117:111013

[48]

Eyster KM.The estrogen receptors: an overview from different perspectives. In: Eyster KM, editor. Estrogen receptors. New York: Springer; 2016. pp. 1-10.

[49]

Li Y,Li S.N-myc downstream-regulated gene 2, a novel estrogen-targeted gene, is involved in the regulation of Na+/K+-ATPase.J Biol Chem2011;286:32289-99

[50]

Tham YK,Claridge B.Estrogen receptor alpha deficiency in cardiomyocytes reprograms the heart-derived extracellular vesicle proteome and induces obesity in female mice.Nat Cardiovasc Res2023;2:268-89

[51]

Feng X,Wu J.The role of estrogen and its membrane receptor G protein-coupled estrogen pathway in regulating glucose and lipid metabolism and imbalance of inflammatory response: the latest research progress.Chin J Geriatr2021;40:393-6

[52]

Mahboobifard F,Jorjani M.Estrogen as a key regulator of energy homeostasis and metabolic health.Biomed Pharmacother2022;156:113808

[53]

Nakamura Y,Suzuki T.Steroid sulfatase and estrogen sulfotransferase in the atherosclerotic human aorta.Am J Pathol2003;163:1329-39

[54]

Johansson T,Bliuc D.Contemporary menopausal hormone therapy and risk of cardiovascular disease: swedish nationwide register based emulated target trial.BMJ2024;387:e078784 PMCID:PMC11600536

[55]

Ceperuelo-Mallafré V,Keiran N.Preoperative circulating succinate levels as a biomarker for diabetes remission after bariatric surgery.Diabetes Care2019;42:1956-65

[56]

Osuna-Prieto FJ,Ortiz-Alvarez L.Elevated plasma succinate levels are linked to higher cardiovascular disease risk factors in young adults.Cardiovasc Diabetol2021;20:151 PMCID:PMC8314524

[57]

de Metz J,Endert E.Interferon-γ has immunomodulatory effects with minor endocrine and metabolic effects in humans.J Appl Physiol (1985)1999;86:517-22

[58]

Zorrilla EP.Interleukin-18 null mutation increases weight and food intake and reduces energy expenditure and lipid substrate utilization in high-fat diet fed mice.Brain Behav Immun2014;37:45-53 PMCID:PMC4219830

[59]

Zhou Y,Wang L.Decreased adiponectin and increased inflammation expression in epicardial adipose tissue in coronary artery disease.Cardiovasc Diabetol2011;10:2 PMCID:PMC3032658

[60]

O'Brien LC,Chen Q,Cardozo C.Plasma adiponectin levels are correlated with body composition, metabolic profiles, and mitochondrial markers in individuals with chronic spinal cord injury.Spinal Cord2018;56:863-72 PMCID:PMC6129201

[61]

Adly NN.Risk stratification among metabolically unhealthy obese in independent physically inactive aged women.Diabetes Metab Syndr2019;13:1821-5

[62]

Kizer JR,Arnold AM.Total and high-molecular-weight adiponectin and risk of coronary heart disease and ischemic stroke in older adults.J Clin Endocrinol Metab2013;98:255-63 PMCID:PMC3537098

[63]

Ouchi N,Arita Y.Adipocyte-derived plasma protein, adiponectin, suppresses lipid accumulation and class A scavenger receptor expression in human monocyte-derived macrophages.Circulation2001;103:1057-63

[64]

Zhou Q,Li A.Activating adiponectin signaling with exogenous AdipoRon reduces myelin lipid accumulation and suppresses macrophage recruitment after spinal cord injury.J Neurotrauma2019;36:903-18

[65]

Ehsan M,Lovren F.Adiponectin limits monocytic microparticle-induced endothelial activation by modulation of the AMPK, Akt and NFκB signaling pathways.Atherosclerosis2016;245:1-11

[66]

Okoth K,Marshall T.Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review.BMJ2020;371:m3502 PMCID:PMC7537472

[67]

Willemars MMA,Verdonschot JAJ.Evaluation of the interaction of sex hormones and cardiovascular function and health.Curr Heart Fail Rep2022;19:200-12 PMCID:PMC9329157

[68]

Ning L,Lu C,Zeng T.Association between basal metabolic rate and cardio-metabolic risk factors: evidence from a Mendelian randomization study.Heliyon2024;10:e28154 PMCID:PMC10999873

[69]

Howard BV.Estrogens and cardiovascular disease risk revisited: the Women’s Health Initiative.Curr Opin Lipidol2013;24:493-9 PMCID:PMC4219554

[70]

Florian M,Angle M.Estrogen induced changes in Akt-dependent activation of endothelial nitric oxide synthase and vasodilation.Steroids2004;69:637-45

[71]

Armistead B,VanderKamp R.Placental regulation of energy homeostasis during human pregnancy.Endocrinology2020;161:bqaa076 PMCID:PMC10061055

[72]

Rabadia SV,Cameron NA.Pregnancy complications and long-term atherosclerotic cardiovascular disease risk.Curr Atheroscler Rep2025;27:27 PMCID:PMC11747063

[73]

Xiang D,Zhou S,Wang Y.Protective effects of estrogen on cardiovascular disease mediated by oxidative stress.Oxid Med Cell Longev2021;2021:5523516 PMCID:PMC8260319

[74]

Lovejoy JC,de Jonge L,Smith SR.Increased visceral fat and decreased energy expenditure during the menopausal transition.Int J Obes2008;32:949-58 PMCID:PMC2748330

[75]

El Khoudary SR, Aggarwal B, Beckie TM, et al.; American Heart Association Prevention Science Committee of the Council on Epidemiology and Prevention; and Council on Cardiovascular and Stroke Nursing. Menopause transition and cardiovascular disease risk: implications for timing of early prevention: a scientific statement from the American Heart Association.Circulation2020;142:e506-32

[76]

Reynolds HR,Berry C.Coronary arterial function and disease in women with no obstructive coronary arteries.Circ Res2022;130:529-51

[77]

Thurston RC,Barinas-Mitchell E.Physiologically assessed hot flashes and endothelial function among midlife women.Menopause2018;25:1354-61

[78]

Lam CSP,de Boer RA,van Veldhuisen DJ.Heart failure with preserved ejection fraction: from mechanisms to therapies.Eur Heart J2018;39:2780-92

[79]

Samargandy S,Brooks MM.Arterial stiffness accelerates within 1 year of the final menstrual period: the SWAN heart study.Arterioscler Thromb Vasc Biol2020;40:1001-8

[80]

Fullmer S,Earthman CP.Evidence analysis library review of best practices for performing indirect calorimetry in healthy and non-critically ill individuals.J Acad Nutr Diet2015;115:1417-1446.e2

[81]

Berger MM,Gramlich L.How to interpret and apply the results of indirect calorimetry studies: a case-based tutorial.Clin Nutr ESPEN2024;63:856-69

[82]

McLean JA.Animal and human calorimetry. Cambridge: Cambridge University Press, 1988.

[83]

Bendavid I,Barazzoni R.The centenary of the Harris-Benedict equations: how to assess energy requirements best? Recommendations from the ESPEN expert group.Clin Nutr2021;40:690-701

[84]

Brandi LS,Calafà M.Indirect calorimetry in critically ill patients: clinical applications and practical advice.Nutrition1997;13:349-58

[85]

Ukleja A,Szczygieł B,Słodkowski M.Indirect calorimetry, indications, interpretation, and clinical application.Postępy Żywienia Klinicznego2023;18:22-8

[86]

Haugen HA,Li F.Indirect calorimetry: a practical guide for clinicians.Nutr Clin Pract2007;22:377-88

[87]

Mtaweh H,Floh AA.Indirect calorimetry: history, technology, and application.Front Pediatr2018;6:257 PMCID:PMC6157446

[88]

Sabounchi NS,Ammerman A.Best-fitting prediction equations for basal metabolic rate: informing obesity interventions in diverse populations.Int J Obes2013;37:1364-70 PMCID:PMC4278349

[89]

Teixeira PFDS,Pazos-Moura CC.The role of thyroid hormone in metabolism and metabolic syndrome.Ther Adv Endocrinol Metab2020;11:2042018820917869 PMCID:PMC7238803

[90]

Mullur R,Brent GA.Thyroid hormone regulation of metabolism.Physiol Rev2014;94:355-82 PMCID:PMC4044302

[91]

Li ZZ,Wang JL,Ming J. Reference intervals for thyroid-stimulating hormone and thyroid hormones using the access TSH 3rd IS method in China. J Clin Lab Anal 2020;34:e23197.[PMID:31912542 DOI:10.1002/jcla.23197 PMCID:PMC7246370] Caution!

[92]

Flammer AJ,Celermajer DS.The assessment of endothelial function: from research into clinical practice.Circulation2012;126:753-67

[93]

Bonetti PO,Higano ST,Kuvin JT.Noninvasive identification of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia.J Am Coll Cardiol2004;44:2137-41

[94]

Murthy VL,Pico AR.Comprehensive metabolic phenotyping refines cardiovascular risk in young adults.Circulation2020;142:2110-27

[95]

Riggs AJ,Gropper SS.Changes in energy expenditure associated with ingestion of high protein, high fat versus high protein, low fat meals among underweight, normal weight, and overweight females.Nutr J2007;6:40 PMCID:PMC2211287

[96]

Dickerson RN.Medication effects on metabolic rate: a systematic review (part 1).J Am Diet Assoc2005;105:835-43

[97]

Dickerson RN.Medication effects on metabolic rate: a systematic review (part 2).J Am Diet Assoc2005;105:1002-9

[98]

Swedenborg E,Cai W,Rüegg J.Regulation of estrogen receptor beta activity and implications in health and disease.Cell Mol Life Sci2009;66:3873-94 PMCID:PMC11115682

[99]

Barros RP.Estrogen receptors and the metabolic network.Cell Metab2011;14:289-99

[100]

Zahr T,Ge J.Small molecule conjugates with selective estrogen receptor β agonism promote anti-aging benefits in metabolism and skin recovery.Acta Pharm Sin B2024;14:2137-52 PMCID:PMC11119546

[101]

Foryst-Ludwig A.Metabolic impact of estrogen signalling through ERalpha and ERbeta.J Steroid Biochem Mol Biol2010;122:74-81

[102]

Bi X,Goh AT.Basal metabolic rate and body composition predict habitual food and macronutrient intakes: gender differences.Nutrients2019;11:2653 PMCID:PMC6893862

[103]

Guasch-Ferré M,Palmnäs M.Precision nutrition for cardiometabolic diseases.Nat Med2025;31:1444-53

[104]

Mitchell L,Duthie G.Methods to assess energy expenditure of resistance exercise: a systematic scoping review.Sports Med2024;54:2357-72 PMCID:PMC11393209

[105]

Wang X,Xu Z.Predictive equation for basal metabolic rate in normal-weight chinese adults.Nutrients2023;15:4185 PMCID:PMC10574416

[106]

Wang Z,Schautz B.Mechanistic model of mass-specific basal metabolic rate: evaluation in healthy young adults.Int J Body Compos Res2011;9:147

[107]

Arciero PJ,He F.Protein-pacing caloric-restriction enhances body composition similarly in obese men and women during weight loss and sustains efficacy during long-term weight maintenance.Nutrients2016;8:476 PMCID:PMC4997389

[108]

Syngle V.Determinants of basal metabolic rate in Indian obese patients.Obesity Medicine2020;17:100175

[109]

Huang HYR,Zhang D.Deep metabolic phenotyping of humans with protein-altering variants in TM6SF2 using a genome-first approach.JHEP Rep2025;7:101243 PMCID:PMC11647476

[110]

Wiechert W.13C metabolic flux analysis.Metab Eng2001;3:195-206

[111]

Long CP.High-resolution 13C metabolic flux analysis.Nat Protoc2019;14:2856-77

[112]

Cheah YE.Isotopically nonstationary metabolic flux analysis (INST-MFA): putting theory into practice.Curr Opin Biotechnol2018;54:80-7

[113]

Magrini ML,Lazzarini F,Gregori D.Wearable devices for caloric intake assessment: state of art and future developments.Open Nurs J2017;11:232-40 PMCID:PMC5712649

[114]

Gu L.The application of smart wearable devices in the detection of sports energy consumption: a review.Intell Sports Health2025;1:67-78

PDF

44

Accesses

0

Citation

Detail

Sections
Recommended

/