Key Points
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Cardiac troponin level is prognostic for adverse cardiovascular outcomes in both sexes
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Increasingly sensitive assays for cardiac troponins will renew focus on sex-specific differences in troponin concentrations, and might increase the relevance of sex-specific cut-off points for diagnosis, prognosis, and risk prediction
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Healthy women have a higher natriuretic peptide level than healthy men, but the same cut-off points for diagnosis and prognosis of heart failure can generally be used in both sexes
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Soluble ST2 level is lower in healthy women than healthy men; however; a cut-off point of 35 ng/ml seems to be robust for prognosis in both sexes with heart failure
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Proneurotensin might improve prediction of incident cardiovascular disease, diabetes mellitus, and breast cancer in women, although further studies are needed to confirm these associations
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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L.B.D. declares that she has received speaking fees from Critical Diagnostics and Roche Diagnostics, and has served as a consultant for diaDexus. A.S.M. declares that he has received research support from Abbott, Alere, Critical Diagnostics, ResMed, Roche Diagnostics, and Sphingotec; and consulting fees from Alere, BG Medicine, Critical Diagnostics, diaDexus, and Sphingotec.
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Daniels, L., Maisel, A. Cardiovascular biomarkers and sex: the case for women. Nat Rev Cardiol 12, 588–596 (2015). https://doi.org/10.1038/nrcardio.2015.105
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DOI: https://doi.org/10.1038/nrcardio.2015.105
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