Sex differences in ischemic heart disease and heart failure biomarkers

Area of Science:

• Cardiology
• Biomarker Research
• Sex-Based Medicine

Background:

• Women experience higher mortality rates from ischemic heart disease (IHD) and heart failure (HF) despite lower diagnosis rates compared to men.
• Current diagnostic approaches, particularly biomarker assessments, may not adequately account for sex-based differences, potentially leading to underdiagnosis in women.

Purpose of the Study:

• To highlight the importance of understanding sex-based differences in cardiac biomarker utility.
• To advocate for the development and implementation of sex-specific reference intervals for cardiac biomarkers to improve diagnostic accuracy and patient outcomes in women.

Main Methods:

• Review of existing literature on cardiac biomarker assessment in men versus women.
• Analysis of specific biomarkers such as troponin, hsCRP, and BNP, considering their differential utility based on sex.
• Discussion of the implications of "unisex" reference intervals versus sex-specific thresholds.

Main Results:

• "Unisex" troponin reference intervals may lead to under-diagnosis of myocardial necrosis in women.
• High-sensitivity C-reactive protein (hsCRP) and B-type natriuretic peptide (BNP) may offer improved risk stratification in women when sex-specific thresholds are applied.
• Current diagnostic tools may exacerbate the diagnostic gap between men and women due to a lack of sex-specific calibration.

Conclusions:

• Sex-specific reference intervals or cutoffs for laboratory tests are essential for accurate cardiovascular disease assessment.
• Implementing sex-specific biomarker thresholds can help close the diagnostic gap, leading to more timely and appropriate management for women.
• Further research and clinical adoption of sex-specific diagnostic criteria are necessary to improve morbidity and mortality rates in women for IHD and HF.