Sex Differences in Cardiac Troponin I and T and the Prediction of Cardiovascular Events in the General Population

D.M. Kimenai, A.S.V. Shah, D.A. McAllister, K.K. Lee, A. Tsanas, S.J.R. Meex, D.J. Porteous, C. Hayward, A. Campbell, N. Sattar, N.L. Mills*, P. Welsh

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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BACKGROUND: Cardiac troponin concentrations differ in women and men, but how this influences risk prediction and whether a sex-specific approach is required is unclear. We evaluated whether sex influences the predictive ability of cardiac troponin I and T for cardiovascular events in the general population.METHODS: High-sensitivity cardiac troponin (hs-cTn) I and T were measured in the Generation Scotland Scottish Family Health Study of randomly selected volunteers drawn from the general population between 2006 and 2011. Cox-regression models evaluated associations between hs-cTnI and hs-cTnT and the primary outcome of cardiovascular death, myocardial infarction, or stroke.RESULTS: In 19501 (58% women, mean age 47years) participants, the primary outcome occurred in 2.7% (306/11375) of women and 5.1% (411/8126) of men during the median follow-up period of 7.9 (IQR, 7.1-9.2) years. Cardiac troponin I and T concentrations were lower in women than men (P<0.001 for both), and both were more strongly associated with cardiovascular events in women than men. For example, at a hs-cTnI concentration of 10ng/L, the hazard ratio relative to the limit of blank was 9.7 (95% CI 7.6-12.4) and 5.6 (95% CI 4.7-6.6) for women and men, respectively. The hazard ratio for hs-cTnT at a concentration of 10ng/L relative to the limit of blank was 3.7 (95% CI 3.1-4.3) and 2.2 (95% CI 2.0-2.5) for women and men, respectively.CONCLUSIONS: Cardiac troponin concentrations differ in women and men and are stronger predictors of cardiovascular events in women. Sex-specific approaches are required to provide equivalent risk prediction.
Original languageEnglish
Pages (from-to)1351-1360
Number of pages10
JournalClinical Chemistry
Issue number10
Publication statusPublished - 1 Oct 2021


  • sex
  • cardiac troponin
  • risk factors
  • cardiovascular events
  • RISK

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