Sex Differences in the Prognostic Value of Circulating Biomarkers in Patients Presenting With Acute Chest Pain

Gard Mikael Sæle Myrmel, MD; Nasir Saeed; Ole Thomas Steiro, MD; Hilde Lunde Tjora, MD, PhD; Jørund Langørgen, MD, PhD; Rune Oskar Bjørneklett, MD, PhD; Øyvind Skadberg, MD; Vernon Vijay Singha Bonarjee, MD, PhD; Øistein Rønneberg Mjelva, MD; Eva Ringdal Pedersen, MD, PhD; Kjell Vikenes, MD, PhD; Torbjørn Omland, MD, PhD; Kristin Moberg Aakre, MD, PhD

JACC: Advances (Feb 2025)

Sex Differences in the Prognostic Value of Circulating Biomarkers in Patients Presenting With Acute Chest Pain

Gard Mikael Sæle Myrmel, MD,
Nasir Saeed,
Ole Thomas Steiro, MD,
Hilde Lunde Tjora, MD, PhD,
Jørund Langørgen, MD, PhD,
Rune Oskar Bjørneklett, MD, PhD,
Øyvind Skadberg, MD,
Vernon Vijay Singha Bonarjee, MD, PhD,
Øistein Rønneberg Mjelva, MD,
Eva Ringdal Pedersen, MD, PhD,
Kjell Vikenes, MD, PhD,
Torbjørn Omland, MD, PhD,
Kristin Moberg Aakre, MD, PhD

Affiliations

Gard Mikael Sæle Myrmel, MD: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
Nasir Saeed: Department of Clinical Science, University of Bergen, Bergen, Norway
Ole Thomas Steiro, MD: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
Hilde Lunde Tjora, MD, PhD: Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
Jørund Langørgen, MD, PhD: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
Rune Oskar Bjørneklett, MD, PhD: Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
Øyvind Skadberg, MD: Laboratory of Medical Biochemistry, Stavanger University Hospital, Stavanger, Norway
Vernon Vijay Singha Bonarjee, MD, PhD: Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
Øistein Rønneberg Mjelva, MD: Department of Medicine, Stavanger University Hospital, Stavanger, Norway
Eva Ringdal Pedersen, MD, PhD: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
Kjell Vikenes, MD, PhD: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
Torbjørn Omland, MD, PhD: K.G. Jebsen Centre for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Akershus University Hospital, Oslo, Norway
Kristin Moberg Aakre, MD, PhD: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway; Address for correspondence: Prof Kristin M Aakre, Department of Heart Disease, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Jonas Lies vei 65, Bergen, Norway.

Journal volume & issue: Vol. 4, no. 2
p. 101567

Abstract

Read online

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 (hs-cTn), 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-cTn and hs-cTnI concentration was associated with a higher adjusted hazard ratio in women (hs-cTn: 1.3, 95% CI: 1.2-1.5; hs-cTnI: 1.2, 95% CI: 1.1-1.2) than in men (hs-cTn: 1.1, 95% CI: 1.0-1.2; hs-cTnI: 1.0, 95% CI: 1.0-1.1); P value for interaction with sex: 0.009 (hs-cTn) 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-cTn, 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.

Published in JACC: Advances

ISSN: 2772-963X (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/jacc-advances

About the journal

Abstract

Keywords