The use of circulating biomarkers for heart failure (HF) is ingrained in contemporary cardiovascular practice and provides objective information about various pathophysiological pathways associated with HF syndrome. However variation in plasma concentrations among men and women may affect their interpretation and utility in the clinical setting.
In this article published in the European Journal of Heart Failure, Navin Suthahar et al. summarized data on sex-specific dynamics of clinically relevant HF biomarkers in the general population as well as in HF patients.
Interestingly, biomarkers displaying lower levels in healthy women (cardiac troponins and sST2) also display lower levels in women with HF. By contrast, biomarkers displaying higher levels in healthy women (natriuretic peptides [NPs] and galectin-3) do not consistently exhibit higher levels in women with HF. They also discussed the overlapping effects of sex and obesity, particularly for NPs. While lower NP levels in heavier individuals can be better explained by (male) sex than by obesity in the general population, obesity-associated lowering of NPs appears to be more relevant than sex-related effects in HF population. Overall, they highlighted the fact that our current understanding of factors contributing to sex-related differences in HF biomarkers, and the clinical relevance of these findings, is insufficient. They identified several knowledge gaps that could potentially serve as focus points for future research in sex-related differences in HF biomarkers.