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Cardiovascular biomarkers and sex: the case for women
Lori B Daniels1, Alan S Maisel1
1Division of Cardiovascular Medicine, University of California, 9444 Medical Center Drive, La Jolla, CA 92037-7411, USA.
Insights
Sex-specific differences in cardiovascular biomarkers exist, but most are similarly effective for men and women. High-sensitivity troponin assays and proneurotensin may offer sex-specific diagnostic or prognostic value.
Area of Science:
- Cardiology
- Biomarker Research
- Sex Differences in Medicine
Background:
- Cardiovascular disease (CVD) management relies heavily on biomarker measurement.
- Physiological and clinical manifestations of CVD can differ between sexes.
- Current clinical practice often overlooks potential sex-specific variations in biomarker behavior.
Purpose of the Study:
- To evaluate the impact of sex on the interpretation and utility of cardiovascular biomarkers.
- To identify biomarkers where sex-specific differences significantly alter diagnostic or prognostic value.
- To explore how understanding sex differences can enhance CVD care and physiological insights.
Main Methods:
- Review of existing literature on sex-specific differences in cardiovascular biomarkers.
- Analysis of baseline concentrations and clinical performance of common biomarkers (e.g., troponin, natriuretic peptides, galectin-3, soluble ST2).
- Examination of potential sex-based cut-off points and their diagnostic/prognostic implications.
Main Results:
- Most cardiovascular biomarkers show similar diagnostic and prognostic utility across sexes, despite differing baseline concentrations.
- High-sensitivity troponin assays may benefit from sex-specific cut-offs due to lower levels in women.
- Proneurotensin shows potential as a sex-specific predictor of CVD in women and may also indicate breast cancer risk.
Conclusions:
- While most biomarkers are sex-agnostic in clinical use, understanding sex differences is crucial for optimizing their application.
- Sex-specific cut-offs for high-sensitivity troponins could improve myocardial infarction diagnosis in women.
- Proneurotensin warrants further investigation as a potentially unique biomarker for women's cardiovascular and cancer risk.
Abstract:
Measurement of biomarkers is a critical component of cardiovascular care. Women and men differ in their cardiac physiology and manifestations of cardiovascular disease. Although most cardiovascular biomarkers are used by clinicians without taking sex into account, sex-specific differences in biomarkers clearly exist. Baseline concentrations of many biomarkers (including cardiac troponin, natriuretic peptides, galectin-3, and soluble ST2) differ in men versus women, but these sex-specific differences do not generally translate into a need for differential sex-based cut-off points. Furthermore, most biomarkers are similarly diagnostic and prognostic, regardless of sex. Two potential exceptions are cardiac troponins measured by high-sensitivity assay, and proneurotensin. Troponin levels are lower in women than in men and, with the use of high-sensitivity assays, sex-specific cut-off points might improve the diagnosis of myocardial infarction. Proneurotensin is a novel biomarker that was found to be predictive of incident cardiovascular disease in women, but not men, and was also predictive of incident breast cancer. If confirmed, proneurotensin might be a unique biomarker of disease risk in women. With any biomarker, an understanding of sex-specific differences might improve its use and might also lead to an enhanced understanding of the physiological differences between the hearts of men and women.
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