Sex Differences in Ischemic Heart Disease and Heart Failure Biomarkers

Overview

Journal Biol Sex Differ

Publisher Biomed Central

Specialties Biology
Physiology

Date 2018 Sep 19

PMID 30223899

Citations 21

Authors

Kimia Sobhani

Diana K Nieves Castro

Qin Fu

Roberta A Gottlieb

Jennifer E Van Eyk

C Noel Bairey Merz

Affiliations

Soon will be listed here.

Abstract

Since 1984, each year, more women than men die of ischemic heart disease (IHD) and heart failure (HF), yet more men are diagnosed. Because biomarker assessment is often the first diagnostic employed in such patients, understanding biomarker differences in men vs. women may improve female morbidity and mortality rates.Some key examples of cardiac biomarker utility based on sex include contemporary use of "unisex" troponin reference intervals under-diagnosing myocardial necrosis in women; greater use of hsCRP in the setting of acute coronary syndrome (ACS) could lead to better stratification in women; and greater use of BNP with sex-specific thresholds in ACS could also lead to more timely risk stratification in women.Accurate diagnosis, appropriate risk management, and monitoring are key in the prevention and treatment of cardiovascular diseases; however, the assessment tools used must also be useful or at least assessed for utility in both sexes. In other words, going forward, we need to evaluate sex-specific reference intervals or cutoffs for laboratory tests used to assess cardiovascular disease to help close the diagnostic gap between men and women.

Citing Articles

Sex differences research is important!.

Becker J, Ahmed S Biol Sex Differ. 2025; 16(1):20.

PMID: 40065326 PMC: 11892286. DOI: 10.1186/s13293-025-00702-x.

Sex-Based Performance Disparities in Machine Learning Algorithms for Cardiac Disease Prediction: Exploratory Study.

Straw I, Rees G, Nachev P J Med Internet Res. 2024; 26:e46936.

PMID: 39186324 PMC: 11384168. DOI: 10.2196/46936.

Psychological Health and Ischemic Heart Disease in Women: A Review of Current Evidence and Clinical Considerations across the Healthspan.

Gaffey A, Spatz E Curr Atheroscler Rep. 2024; 26(3):45-58.

PMID: 38240928 PMC: 11219074. DOI: 10.1007/s11883-023-01185-0.

A bibliometric analysis of acute myocardial infarction in women from 2000 to 2022.

Xu M, Yang F, Shen B, Wang J, Niu W, Chen H Front Cardiovasc Med. 2023; 10:1090220.

PMID: 37576112 PMC: 10416645. DOI: 10.3389/fcvm.2023.1090220.

Inequalities in premature mortality from ischaemic heart disease in the WHO European region.

Nemeth N, Boncz I, Pakai A, Elmer D, Horvath L, Ponusz R Cent Eur J Public Health. 2023; 31(2):120-126.

PMID: 37451245 DOI: 10.21101/cejph.a7287.

References

Regitz-Zagrosek V, Lehmkuhl E, Lehmkuhl H, Hetzer R . Gender aspects in heart failure. Pathophysiology and medical therapy. Arch Mal Coeur Vaiss. 2004; 97(9):899-908. View

Nakada Y, Kawakami R, Nakano T, Takitsume A, Nakagawa H, Ueda T . Sex differences in clinical characteristics and long-term outcome in acute decompensated heart failure patients with preserved and reduced ejection fraction. Am J Physiol Heart Circ Physiol. 2016; 310(7):H813-20. DOI: 10.1152/ajpheart.00602.2015. View

. Biomarkers and surrogate endpoints: preferred definitions and conceptual framework. Clin Pharmacol Ther. 2001; 69(3):89-95. DOI: 10.1067/mcp.2001.113989. View

Melander O, Maisel A, Almgren P, Manjer J, Belting M, Hedblad B . Plasma proneurotensin and incidence of diabetes, cardiovascular disease, breast cancer, and mortality. JAMA. 2012; 308(14):1469-75. DOI: 10.1001/jama.2012.12998. View

Arena R, Arrowood J, Fei D, Helm S, Kraft K . The relationship between C-reactive protein and other cardiovascular risk factors in men and women. J Cardiopulm Rehabil. 2006; 26(5):323-7. DOI: 10.1097/00008483-200609000-00009. View

Witt H, Schubert C, Jaekel J, Fliegner D, Penkalla A, Tiemann K . Sex-specific pathways in early cardiac response to pressure overload in mice. J Mol Med (Berl). 2008; 86(9):1013-24. PMC: 2517094. DOI: 10.1007/s00109-008-0385-4. View

Dey S, Flather M, Devlin G, Brieger D, Gurfinkel E, Steg P . Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events. Heart. 2008; 95(1):20-6. DOI: 10.1136/hrt.2007.138537. View

Keyzer J, Hoffmann J, Ringoir L, Nabbe K, Widdershoven J, Pop V . Age- and gender-specific brain natriuretic peptide (BNP) reference ranges in primary care. Clin Chem Lab Med. 2014; 52(9):1341-6. DOI: 10.1515/cclm-2013-0791. View

Ford E, Giles W, Myers G, Rifai N, Ridker P, Mannino D . C-reactive protein concentration distribution among US children and young adults: findings from the National Health and Nutrition Examination Survey, 1999-2000. Clin Chem. 2003; 49(8):1353-7. DOI: 10.1373/49.8.1353. View

10.

Cullen L, Mills N . Point: The Use of Sex-Specific Cutpoints for High-Sensitivity Cardiac Troponin Assays. Clin Chem. 2016; 63(1):261-263. DOI: 10.1373/clinchem.2016.254672. View

11.

Qasim A, Budharaju V, Mehta N, St Clair C, Farouk S, Braunstein S . Gender differences in the association of C-reactive protein with coronary artery calcium in type-2 diabetes. Clin Endocrinol (Oxf). 2010; 74(1):44-50. PMC: 3005137. DOI: 10.1111/j.1365-2265.2010.03879.x. View

12.

Rogowski O, Zeltser D, Shapira I, Burke M, Zakut V, Mardi T . Gender difference in C-reactive protein concentrations in individuals with atherothrombotic risk factors and apparently healthy ones. Biomarkers. 2004; 9(1):85-92. DOI: 10.1080/13547500410001670303. View

13.

Shaw L, Bugiardini R, Merz C . Women and ischemic heart disease: evolving knowledge. J Am Coll Cardiol. 2009; 54(17):1561-75. PMC: 2789479. DOI: 10.1016/j.jacc.2009.04.098. View

14.

Naesgaard P, Leon De La Fuente R, Nilsen S, Woie L, Aarsland T, Staines H . Vitamin d predicts all-cause and cardiac mortality in females with suspected acute coronary syndrome: a comparison with brain natriuretic Peptide and high-sensitivity C-reactive protein. Cardiol Res Pract. 2013; 2013:398034. PMC: 3855936. DOI: 10.1155/2013/398034. View

15.

Lopez-Sendon J . To BNP or not to BNP. Eur Heart J. 2013; 34(32):2498-500. DOI: 10.1093/eurheartj/eht262. View

16.

Shah A, Griffiths M, Lee K, McAllister D, Hunter A, Ferry A . High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study. BMJ. 2015; 350:g7873. PMC: 4301191. DOI: 10.1136/bmj.g7873. View

17.

Ford E, Capewell S . Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates. J Am Coll Cardiol. 2007; 50(22):2128-32. DOI: 10.1016/j.jacc.2007.05.056. View

18.

Eggers K, Oldgren J, Nordenskjold A, Lindahl B . Diagnostic value of serial measurement of cardiac markers in patients with chest pain: limited value of adding myoglobin to troponin I for exclusion of myocardial infarction. Am Heart J. 2004; 148(4):574-81. DOI: 10.1016/j.ahj.2004.04.030. View

19.

Safstrom K, Lindahl B, Swahn E . Risk stratification in unstable coronary artery disease--exercise test and troponin T from a gender perspective. FRISC-Study Group. Fragmin during InStability in Coronary artery disease. J Am Coll Cardiol. 2000; 35(7):1791-800. DOI: 10.1016/s0735-1097(00)00655-0. View

20.

Gore M, Seliger S, deFilippi C, Nambi V, Christenson R, Hashim I . Age- and sex-dependent upper reference limits for the high-sensitivity cardiac troponin T assay. J Am Coll Cardiol. 2014; 63(14):1441-8. PMC: 3984900. DOI: 10.1016/j.jacc.2013.12.032. View