Sex differences in associations of plasma metabolites with blood pressure and heart rate variability: The HELIUS study

Atherosclerosis. 2023 Nov:384:117147. doi: 10.1016/j.atherosclerosis.2023.05.016. Epub 2023 May 28.


Background and aims: Since plasma metabolites can modulate blood pressure (BP) and vary between men and women, we examined sex differences in plasma metabolite profiles associated with BP and sympathicovagal balance. Our secondary aim was to investigate associations between gut microbiota composition and plasma metabolites predictive of BP and heart rate variability (HRV).

Methods: From the HELIUS cohort, we included 196 women and 173 men. Office systolic BP and diastolic BP were recorded, and heart rate variability (HRV) and baroreceptor sensitivity (BRS) were calculated using finger photoplethysmography. Plasma metabolomics was measured using untargeted LC-MS/MS. Gut microbiota composition was determined using 16S sequencing. We used machine learning models to predict BP and HRV from metabolite profiles, and to predict metabolite levels from gut microbiota composition.

Results: In women, best predicting metabolites for systolic BP included dihomo-lineoylcarnitine, 4-hydroxyphenylacetateglutamine and vanillactate. In men, top predictors included sphingomyelins, N-formylmethionine and conjugated bile acids. Best predictors for HRV in men included phenylacetate and gentisate, which were associated with lower HRV in men but not in women. Several of these metabolites were associated with gut microbiota composition, including phenylacetate, multiple sphingomyelins and gentisate.

Conclusions: Plasma metabolite profiles are associated with BP in a sex-specific manner. Catecholamine derivatives were more important predictors for BP in women, while sphingomyelins were more important in men. Several metabolites were associated with gut microbiota composition, providing potential targets for intervention.

Keywords: Blood pressure; Heart rate variability; Hypertension; Metabolomics; Sex differences.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Pressure / physiology
  • Chromatography, Liquid
  • Female
  • Gentisates
  • Heart Rate / physiology
  • Humans
  • Male
  • Phenylacetates
  • Sex Characteristics*
  • Sphingomyelins*
  • Tandem Mass Spectrometry


  • Sphingomyelins
  • Gentisates
  • Phenylacetates