Key Points• Genetic and nongenetic determiners of MPV substantially differ between males and females in a large population-based study.• MPV in males is significantly determined by the traditional CVRFs, and males with higher MPV are at higher risk of death. Seven single nucleotide polymorphisms (SNPs) for females and 4 SNPs for males were associated with higher MPV. The full model, including age, CVRFs, laboratory parameters, medications, and genetic variation, explained 20.4% of the MPV variance in females and 18.6% in males. The curves of cumulative mortality, stratified for sex, showed worse survival for males only with MPV >9.96 fL vs MPV £9.96 fL (P < .0001). This study provides evidence for heterogeneity in the profile of determinants for MPV between sexes. The observed interactions between genetic variability, CVRFs, and MPV and its association with the development of cardiovascular disease or thrombotic risk need to be further investigated. (Blood. 2016;127(2):251-259)