Different circulating biomarkers in women and men with paroxysmal atrial fibrillation: results from the AF-RISK and RACE V studies

Abstract

Aims: The clinical risk profile of atrial fibrillation (AF) patients is different in men and women. Our aim was to identify sex differences in blood biomarkers in patients with paroxysmal AF.

Methods and results: Sex differences in 92 blood biomarkers were measured in 364 patients included in our discovery cohort, the identification of a risk profile to guide atrial fibrillation therapy (AF-RISK) study, assessed by multivariable logistic regression and enrichment pathway analysis. Findings were subsequently confirmed in 213 patients included in our validation cohort, the Reappraisal of Atrial Fibrillation: Interaction between HyperCoagulability, Electrical remodelling, and Vascular Destabilisation in the Progression of AF (RACE V) study. In the discovery cohort, mean age was 59 ± 12 years, 41% were women. CHA2DS2-VASc-score was 1.6 ± 1.4. A total of 46% had hypertension, 10% diabetes, and 50% had heart failure, predominantly with preserved ejection fraction (47%). In women, activated leucocyte cell adhesion molecule (ALCAM) and fatty acid binding protein-4 (FABP-4) were higher. In men, matrix metalloproteinase-3 (MMP-3), C-C motif chemokine-16 (CCL-16), and myoglobin were higher. In the validation cohort, four out of five biomarkers could be confirmed: levels of ALCAM (P = 1.73 × 10-4) and FABP-4 (P = 2.46 × 10-7) and adhesion biological pathways [false discovery rate (FDR) = 1.23 × 10-8] were higher in women. In men, levels of MMP-3 (P = 4.31 × 10-8) and myoglobin (P = 2.10 × 10-4) and markers for extracellular matrix degradation biological pathways (FDR = 3.59 × 10-9) were higher.

Conclusion: In women with paroxysmal AF, inflammatory biomarkers were more often higher, while in men with paroxysmal AF, biomarkers for vascular remodelling were higher. Our data support the clinical notion that pathophysiological mechanisms in women and men with AF may differ.

Trial registration: Clinicaltrials.gov identifier NCT01510210 for AF-RISK; Clinicaltrials.gov NCT02726698 for RACE V.

Keywords: Atrial fibrillation; Blood biomarkers; Inflammation; Sex differences; Vascular disease.

Graphical abstract

Figure 1

Blood biomarker sex differences in discovery cohort. ALCAM, activated leucocyte cell adhesion molecule; CCL-16, C-C motif chemokine-16; CI, confidence interval; FABP-4, fatty acid binding protein-4; MMP-3, matrix metalloproteinase-3; OR, odds ratio; SD, standard deviation.

Figure 2

Pathway enrichment analysis of biomarkers confirmed in validation cohort. (A) Pathway enrichment analysis with layers of proteins on validated biomarkers in women in comparison to men from both cohorts. (B) Pathway enrichment analysis with layers of proteins on validated biomarkers in men in comparison to women from both cohorts. (C) Biological processes with higher FDR in women in comparison to men. Colours represent biological processes in which the proteins (nodes) are involved as depicted in A. (D) Biological processes with higher FDR in women in comparison to men. Colours represent biological processes in which the proteins (nodes) are involved as depicted in B. ACAN, aggrecan; ALCAM, activated leucocyte cell adhesion molecule; CD6, T-cell differentiation antigen CD6; CNTN1, contactin-1; DCN, decorin; DMP1, dentin matrix acidic phosphoprotein 1; FDR, false discovery rate; GO, Gene Ontology; ICAM1, intercellular adhesion molecule 1; ITGA4, integrin subunit alpha 4; ITGAD, integrin subunit alpha D; ITGAL, integrin subunit alpha L; ITGAM, integrin subunit alpha M; ITGAX, integrin subunit alpha X; ITGB2, integrin subunit beta 2; KEGG, Kyoto Encyclopedia of Genes and Genomes; MMP10, integrin subunit beta 2; MMP3, matrix metalloproteinase-3; PLG, plasminogen; SPP1, secreted phosphoprotein 1; TIMP1, metallopeptidase inhibitor 1.