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Published on: April 17, 2021
Sex-related differences in contemporary biomarkers for heart failure: a review
Navin Suthahar1, Laura M G Meems1, Jennifer E Ho2
1University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands.
Insights
Sex differences significantly impact heart failure (HF) biomarker levels, affecting clinical interpretation. Understanding these variations is crucial for accurate HF diagnosis and management in both men and women.
Area of Science:
- Cardiovascular Medicine
- Biomarker Research
- Sex Differences in Health
Background:
- Circulating biomarkers are integral to heart failure (HF) management, offering insights into pathophysiological processes.
- Significant sex-based differences exist in HF biomarker profiles, with natriuretic peptides and galectin-3 higher in women, and cardiac troponins and sST2 higher in men.
- These disparities may stem from sex-specific HF pathogenesis, hormonal influences, or body composition variations.
Purpose of the Study:
- To review sex-specific patterns of key HF biomarkers in the general population and HF patients.
- To explore the interplay between sex-related and obesity-related effects on biomarker levels.
- To highlight research gaps concerning sex differences in HF biomarkers.
Main Methods:
- Literature review of studies investigating sex differences in HF biomarkers.
- Analysis of biomarker data stratified by sex in general and HF patient populations.
- Synthesis of findings to identify clinical implications and research needs.
Main Results:
- Biomarker profiles for cardiac stretch, fibrosis, injury, and inflammation show distinct patterns between men and women.
- Sex-specific reference ranges may be necessary for accurate interpretation of HF biomarkers.
- Obesity may further modify these sex-related biomarker differences.
Conclusions:
- Sex-specific differences in HF biomarkers are substantial and clinically relevant.
- Current biomarker interpretations may require sex-specific adjustments for optimal HF care.
- Further research is needed to elucidate the mechanisms behind these differences and refine diagnostic/prognostic strategies.
Abstract:
The use of circulating biomarkers for heart failure (HF) is engrained in contemporary cardiovascular practice and provides objective information about various pathophysiological pathways associated with HF syndrome. However, biomarker profiles differ considerably among women and men. For instance, in the general population, markers of cardiac stretch (natriuretic peptides) and fibrosis (galectin-3) are higher in women, whereas markers of cardiac injury (cardiac troponins) and inflammation (sST2) are higher in men. Such differences may reflect sex-specific pathogenic processes associated with HF risk, but may also arise as a result of differences in sex hormone profiles and fat distribution. From a clinical perspective, sex-related differences in biomarker levels may affect the objectivity of biomarkers in HF management because what is considered to be 'normal' in one sex may not be so in the other. The objectives of this review are, therefore: (i) to examine the sex-specific dynamics of clinically relevant HF biomarkers in the general population, as well as in HF patients; (ii) to discuss the overlap between sex-related and obesity-related effects, and (iii) to identify knowledge gaps to stimulate research on sex-related differences in HF.
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