van Koeverden ID, et al. – Researchers investigated whether a low testosterone/estradiol (T/E2) ratio in men with cardiovascular disease (CVD) is associated with increased inflammation, a more unstable plaque, and a worse cardiovascular outcome in this study that included a cohort of 611 male carotid endarterectomy patients. They collected and analyzed blood samples and 3-year follow-up information. Findings revealed increased systemic inflammation, increased inflammatory plaque proteins, and an increased risk of future major cardiovascular events in association with low T/E2 ratio in male patients with manifest atherosclerotic disease vs men with normal T/E2 ratio. In men with elevated BMI, they observed the strongest effects; activity in white fat tissues was expected to influence these effects. Secondary prevention of CVD in men may require normalization of T/E2 ratio.