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Sex Differences in the Prognostic Value of Circulating Biomarkers in Patients Presenting With Acute Chest Pain
Gard Mikael Sæle Myrmel1, Nasir Saeed2, Ole Thomas Steiro1
1Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Insights
Biomarkers like cardiac troponin and NT-proBNP predict cardiovascular events differently in women versus men with suspected acute coronary syndrome. Sex-specific adjustments may improve risk prediction accuracy.
Area of Science:
- Cardiology
- Biomarker Research
- Sex-Based Medicine
Background:
- Biomarkers are crucial for predicting long-term cardiovascular (CV) event risk in patients with suspected acute coronary syndromes.
- Understanding potential sex differences in biomarker prognostic value is essential for personalized risk assessment.
Purpose of the Study:
- To investigate sex-specific differences in the long-term prognostic value of various biomarkers in patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
Main Methods:
- Measured concentrations of high-sensitivity cardiac troponin T (hs-cTnT), hs-cTnI, N-terminal pro-B-type natriuretic peptide (NT-proBNP), GDF-15, and CRP in 1,476 NSTE-ACS patients.
- Followed patients for a median of 1,547 days to assess a composite endpoint of all-cause mortality, myocardial infarction, or heart failure hospitalization.
- Analyzed sex interactions for biomarker prognostic value regarding primary and secondary CV endpoints.
Main Results:
- Elevated hs-cTnT and hs-cTnI concentrations showed a significantly higher adjusted hazard ratio for the primary endpoint in women compared to men (P for interaction < 0.009).
- NT-proBNP also demonstrated a significant sex interaction (P=0.043), with higher risk associated in women.
- GDF-15 and CRP were independent predictors but lacked significant sex interaction for the primary endpoint.
Conclusions:
- Increasing hs-cTnT, hs-cTnI, and NT-proBNP concentrations are associated with a greater risk of death and CV events in female patients with NSTE-ACS compared to males.
- Sex-specific adjustments for hs-cTn and NT-proBNP may enhance the accuracy of long-term CV risk prognostication in both sexes.
Background:
Biomarkers are used for long-term risk prediction of cardiovascular (CV) events in patients presenting with suspected acute coronary syndromes.
Objectives:
This study investigated whether there are sex differences in the long-term prognostic value of biomarkers in patients presenting with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
Methods:
High-sensitivity cardiac troponin T (hs-cTnT), hs-cTnI, N-terminal pro-B-type natriuretic peptide (NT-proBNP), growth differentiation factor (GDF)-15, and C-reactive protein (CRP) concentrations were measured in 1,476 patients admitted with suspected NSTE-ACS. Patients were followed up for a median of 1,547 (IQR: 873-1,842) days until a primary composite endpoint of all-cause mortality, incident myocardial infarction, or heart failure hospitalization. A secondary endpoint of CV death was also registered.
Results:
For the primary endpoint, a log2 increase of hs-cTnT and hs-cTnI concentration was associated with a higher adjusted HR in women (hs-cTnT: 1.3, 95% CI: 1.2-1.5; hs-cTnI: 1.2, 95% CI: 1.1-1.2) than in men (hs-cTnT: 1.1, 95% CI: 1.0-1.2; hs-cTnI: 1.0, 95% CI: 1.0-1.1); P for interaction with sex = 0.009 (hs-cTnT) and 0.005 (hs-cTnI). A similar interaction was shown for NT-proBNP (P for interaction = 0.043). GDF-15 and CRP were independent predictors of the primary endpoint, but the interaction by sex was nonsignificant.
Conclusions:
In contrast to CRP and GDF-15, increasing concentrations of hs-cTnT, hs-cTnI, and NT-proBNP are associated with higher risk of death and CV events in female than in male patients presenting with suspected NSTE-ACS. Sex-adjustment of hs-cTn and NT-proBNP may increase the accuracy of long-term CV prognostication in women and men.
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