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In male patients with manifest atherosclerotic disease, low T/E2 ratio was associated with increased systemic inflammation, increased inflammatory plaque proteins and an increased risk of future major cardiovascular events as compared to men with normal T/E2 ratio. These effects are strongest in men with elevated body mass index and are expected to be affected by aromatase activity in white fat tissues. Normalization of T/E2 ratio may be considered as target for the secondary prevention of CVD in men.