Sex-based differences in biomarker trajectories in acute coronary syndrome patients from the BIOMArCS study

Acute coronary syndrome (ACS) presents sex-based differences in pathophysiology. Variations in biomarker patterns post-ACS, reflecting myocardial injury, vascular inflammation, and remodeling, may indicate critical differences in cardiovascular disease mechanisms and outcomes. We analyzed biomarker patterns in 787 patients (22% females) from the BIOMArCS study, all without re-ACS during the study period. We tracked levels of hs-cTnT, NT-proBNP, hs-CRP, GDF-15, and additional biomarkers in a subcohort of 191 patients over one year. Serial blood samples were collected to compare acute-phase (first month after ACS) and stabilized-phase (2-12 months post-ACS) biomarker trajectories between sexes, adjusting for age, BMI, and kidney function using linear mixed-effects models. Females showed significantly lower hs-cTnT levels (mean 386 pg/mL versus 559 pg/mL in males, p = 0.002 acute phase; 8.5 pg/mL versus 10.8 pg/mL, p < 0.001 at 180 days). NT-proBNP levels were higher in females (mean 70 pmol/L vs. 47 pmol/L, p < 0.001 acute phase; 30 pmol/L vs. 19 pmol/L, p < 0.001 at 180 days). Hs-CRP levels were also elevated in females (mean 1.8 mg/L vs. 1.5 mg/L, p = 0.02 at 180 days). Galectin-3 levels remained higher in females (22.8 ng/mL vs. 18.6 ng/mL, p = 0.03). This study provides the first comprehensive analysis of sex-specific biomarker trajectories following ACS. Distinct differences in hs-cTnT, NT-proBNP, and inflammatory markers suggest that sex-specific diagnostic thresholds and personalized treatment strategies after ACS may be warranted, although their clinical value still needs confirmation in larger prospective studies.