Sex Differences in the Prognostic Value of Circulating Biomarkers in Patients Presenting With Acute Chest Pain
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 wit...
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Elsevier
2025-02-01
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| Series: | JACC: Advances |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772963X24008482 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Gard Mikael Sæle Myrmel, MD |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-f06c64393a5e4c28b98349c9cbf03220 |
| institution | Kabale University |
| issn | 2772-963X |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JACC: Advances |
| spelling | doaj-art-f06c64393a5e4c28b98349c9cbf032202025-01-23T05:28:04ZengElsevierJACC: Advances2772-963X2025-02-0142101567Sex Differences in the Prognostic Value of Circulating Biomarkers in Patients Presenting With Acute Chest PainGard Mikael Sæle Myrmel, MD0Nasir Saeed1Ole Thomas Steiro, MD2Hilde Lunde Tjora, MD, PhD3Jørund Langørgen, MD, PhD4Rune Oskar Bjørneklett, MD, PhD5Øyvind Skadberg, MD6Vernon Vijay Singha Bonarjee, MD, PhD7Øistein Rønneberg Mjelva, MD8Eva Ringdal Pedersen, MD, PhD9Kjell Vikenes, MD, PhD10Torbjørn Omland, MD, PhD11Kristin Moberg Aakre, MD, PhD12Department of Heart Disease, Haukeland University Hospital, Bergen, NorwayDepartment of Clinical Science, University of Bergen, Bergen, NorwayDepartment of Heart Disease, Haukeland University Hospital, Bergen, NorwayEmergency Care Clinic, Haukeland University Hospital, Bergen, NorwayDepartment of Heart Disease, Haukeland University Hospital, Bergen, NorwayEmergency Care Clinic, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, NorwayLaboratory of Medical Biochemistry, Stavanger University Hospital, Stavanger, NorwayDepartment of Cardiology, Stavanger University Hospital, Stavanger, NorwayDepartment of Medicine, Stavanger University Hospital, Stavanger, NorwayDepartment of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, NorwayDepartment of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, NorwayK.G. Jebsen Centre for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Akershus University Hospital, Oslo, NorwayDepartment 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.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.http://www.sciencedirect.com/science/article/pii/S2772963X24008482acute chest painbiomarkersrisk stratificationsex differences |
| spellingShingle | 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 Sex Differences in the Prognostic Value of Circulating Biomarkers in Patients Presenting With Acute Chest Pain JACC: Advances acute chest pain biomarkers risk stratification sex differences |
| title | Sex Differences in the Prognostic Value of Circulating Biomarkers in Patients Presenting With Acute Chest Pain |
| title_full | Sex Differences in the Prognostic Value of Circulating Biomarkers in Patients Presenting With Acute Chest Pain |
| title_fullStr | Sex Differences in the Prognostic Value of Circulating Biomarkers in Patients Presenting With Acute Chest Pain |
| title_full_unstemmed | Sex Differences in the Prognostic Value of Circulating Biomarkers in Patients Presenting With Acute Chest Pain |
| title_short | Sex Differences in the Prognostic Value of Circulating Biomarkers in Patients Presenting With Acute Chest Pain |
| title_sort | sex differences in the prognostic value of circulating biomarkers in patients presenting with acute chest pain |
| topic | acute chest pain biomarkers risk stratification sex differences |
| url | http://www.sciencedirect.com/science/article/pii/S2772963X24008482 |
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