Sex-Related Aspects of Biomarkers in Cardiac Disease

Alma M. A. Mingels*, Dorien M. Kimenai

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapterAcademic

11 Citations (Web of Science)

Abstract

Biomarkers play an important role in the clinical management of cardiac care. In particular, cardiac troponins (cTn) and natriuretic peptides are the cornerstones for the diagnosis of acute myocardial infarction (AMI) and for the diagnosis of heart failure (HF), respectively. Current guidelines do not make a distinction between women and men. However, the commonly used "one size fits all" algorithms are topic of debate to improve assessment of prognosis, particularly in women. Due to the high-sensitivity assays (hs-cTn), lower cTn levels (and 99th percentile upper reference limits) were observed in women as compared with men. Sex-specific diagnostic thresholds may improve the diagnosis ofAMI in women, though clinical relevance remains controversial and more trials are needed. Also other diagnostic aspects are under investigation, like combined biomarkers approach and rapid measurement strategies. For the natriuretic peptides, previous studies observed higher concentrations in women than in men, especially in premenopausal women who might benefit from the cardioprotective actions. Contrary to hs-cTn, natriuretic peptides are particularly incorporated in the ruling-out algorithms for the diagnosis of HF and not ruling-in. Clinical relevance of sex differences here seems marginal, as clinical research has shown that negative predictive values for ruling-out HF were hardly effected when applying a universal diagnostic threshold that is independent from sex or other risk factors. Apart from the diagnostic issues of AMI in women, we believe that in the future most sex-specific benefits of cardiac biomarkers can be obtained in patient follow-up (guiding therapy) and prognostic applications, fitting modern ideas on preventive and personalized medicine.

Original languageEnglish
Title of host publicationSEX-SPECIFIC ANALYSIS OF CARDIOVASCULAR FUNCTION
EditorsPLM Kerkhof, VM Miller
PublisherSpringer
Pages545-564
Number of pages20
ISBN (Print)978-3-319-77931-7
DOIs
Publication statusPublished - 2018

Publication series

SeriesAdvances in Experimental Medicine and Biology
Volume1065
ISSN0065-2598

Keywords

  • Acute myocardial infarction
  • Age dependence
  • Biomarkers
  • Cardiac troponin I
  • Cardiac troponin T
  • Estrogen
  • Heart failure
  • Natriuretic peptides
  • BNP
  • NT-proBNP
  • Pregnancy
  • Review
  • BRAIN NATRIURETIC PEPTIDE
  • ACUTE CORONARY SYNDROMES
  • SENSITIVITY TROPONIN-I
  • MEDICINE PRACTICE GUIDELINES
  • CONGESTIVE-HEART-FAILURE
  • 3RD UNIVERSAL DEFINITION
  • MYOCARDIAL-INFARCTION
  • CARDIOVASCULAR EVENTS
  • RENAL-FUNCTION
  • NT-PROBNP

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