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Review
. 2021 Jan 5:7:617705.
doi: 10.3389/fcvm.2020.617705. eCollection 2020.

Gender-Related Differences in Heart Failure Biomarkers

Germán Cediel  1   2 , Pau Codina  1   2 , Giosafat Spitaleri  1   2 , Mar Domingo  1   2 , Evelyn Santiago-Vacas  1   2 , Josep Lupón  1   2 , Antoni Bayes-Genis  1   2
Affiliations
Review

Gender-Related Differences in Heart Failure Biomarkers

Germán Cediel et al. Front Cardiovasc Med. .

Abstract

Important differences in comorbidities and clinical characteristics exist between women and men with heart failure (HF). In particular, differences in the kinetics of biological circulating biomarkers-a critical component of cardiovascular care-are highly relevant. Most circulating HF biomarkers are assessed daily by clinicians without taking sex into account, despite the multiple gender-related differences observed in plasma concentrations. Even in health, compared to men, women tend to exhibit higher levels of natriuretic peptides and galectin-3 and lower levels of cardiac troponins and the cardiac stress marker, soluble ST2. Many biological factors can provide a reliable explanation for these differences, like body composition, fat distribution, or menopausal status. Notwithstanding, these sex-specific differences in biomarker levels do not reflect different pathobiological mechanisms in HF between women and men, and they do not necessarily imply a need to use different diagnostic cut-off levels in clinical practice. To date, the sex-specific prognostic value of HF biomarkers for risk stratification is an unresolved issue that future research must elucidate. This review outlines current evidence regarding gender-related differences in circulating biomarkers widely used in HF, the pathophysiological mechanisms underlying these differences, and their clinical relevance.

Keywords: Galectine-3; ST2; biomarker; gender; heart failure; natriuretic peptide; troponin.

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Conflict of interest statement

AB-G has received speaker fees from Roche Diagnostics. AB-G and JL report a relationship with Critical Diagnostics. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Schematic of factors contributing to sex-related differences in HF biomarkers. HF, heart failure; Gal-3, Galectine 3; NT-proBNP, N-terminal pro-B-type natriuretic peptide; cTn, cardiac troponin; sST2, soluble interleukin-like receptor-like-1.
Figure 2
Figure 2
Distribution of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in both sexes. Reproduced with permission from Suthahar et al. (43).
Figure 3
Figure 3
Representation of a lack of coincidences between mechanisms that affect heart failure progression and gender particularities in the context of biomarker levels' variability. HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; NP, natriuretic peptide; Gal-3, Galectine 3; sST2, soluble interleukin-like receptor-like-1.
See this image and copyright information in PMC

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