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.