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. 2021 Oct 1;67(10):1351-1360.
doi: 10.1093/clinchem/hvab109.

Sex Differences in Cardiac Troponin I and T and the Prediction of Cardiovascular Events in the General Population

Dorien M Kimenai  1 , Anoop S V Shah  1   2 , David A McAllister  3 , Kuan Ken Lee  2 , Athanasios Tsanas  1 , Steven J R Meex  4   5 , David J Porteous  6 , Caroline Hayward  6 , Archie Campbell  6 , Naveed Sattar  7 , Nicholas L Mills  1   2 , Paul Welsh  7
Affiliations

Sex Differences in Cardiac Troponin I and T and the Prediction of Cardiovascular Events in the General Population

Dorien M Kimenai et al. Clin Chem. .

Abstract

Background: Cardiac troponin concentrations differ in women and men, but how this influences risk prediction and whether a sex-specific approach is required is unclear. We evaluated whether sex influences the predictive ability of cardiac troponin I and T for cardiovascular events in the general population.

Methods: High-sensitivity cardiac troponin (hs-cTn) I and T were measured in the Generation Scotland Scottish Family Health Study of randomly selected volunteers drawn from the general population between 2006 and 2011. Cox-regression models evaluated associations between hs-cTnI and hs-cTnT and the primary outcome of cardiovascular death, myocardial infarction, or stroke.

Results: In 19 501 (58% women, mean age 47 years) participants, the primary outcome occurred in 2.7% (306/11 375) of women and 5.1% (411/8126) of men during the median follow-up period of 7.9 (IQR, 7.1-9.2) years. Cardiac troponin I and T concentrations were lower in women than men (P < 0.001 for both), and both were more strongly associated with cardiovascular events in women than men. For example, at a hs-cTnI concentration of 10 ng/L, the hazard ratio relative to the limit of blank was 9.7 (95% CI 7.6-12.4) and 5.6 (95% CI 4.7-6.6) for women and men, respectively. The hazard ratio for hs-cTnT at a concentration of 10 ng/L relative to the limit of blank was 3.7 (95% CI 3.1-4.3) and 2.2 (95% CI 2.0-2.5) for women and men, respectively.

Conclusions: Cardiac troponin concentrations differ in women and men and are stronger predictors of cardiovascular events in women. Sex-specific approaches are required to provide equivalent risk prediction.

Keywords: cardiac troponin; cardiovascular events; risk factors; sex.

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Figures

Fig. 1.
Fig. 1.
Distribution of cardiac troponins in women and men. Violin plots of cardiac troponin I (A) and T (B) distribution, stratified by sex (cardiac troponin I, women, 1.5 (1.2–2.5) ng/L versus men 2.5 (1.6–4.0) ng/L; cardiac troponin T, women ≤3.0 (3.0–4.8) ng/L versus men 4.6 (3.0–7.5) ng/L, P < 0.001 for both; n = 11 375 for women, and n = 8126 for men).
Fig. 2.
Fig. 2.
Hazard ratio plots for 5-year risk composite cardiovascular events. Troponin I: (A), unadjusted model; (B), adjusted model and T: (C), unadjusted model; and (D), adjusted model concentrations in relation to composite cardiovascular events, stratified by sex (referent = LoB value). The horizontal dashed line represents the doubling in risk of having a cardiovascular event within 5 years and the vertical dashed lines (red, women; gray, men) respresents the sex-specific thresholds of the 2-fold higher likelihood experiencing a cardiovascular event, accordingly.
Fig. 3.
Fig. 3.
Comparison of the discrimination of cardiac troponins for the prediction of the composite cardiovascular event in women and men. Receiver-operating-curve for cardiac troponin I (A) and cardiac troponin T (B) to predict the composite cardiovascular event at 5 years in women and men.
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