Physicians' Academy for Cardiovascular Education

Similar association between CV risk factors and biomarkers with incident HF in men and women

Sex-specific associations of cardiovascular risk factors and biomarkers with incident heart failure

Literature - Suthahar N, Lau ES, Michael JB, et al. - J Am Coll Cardiol. 2020 Sep 22;76(12):1455-1465. doi: 10.1016/j.jacc.2020.07.044.

Introduction and methods

Lifetime risk estimates in individuals with heart failure (HF) are comparable in males and females, yet the biological response to HF precursors differs [1-6]. For instance, female hearts tend to remodel in a concentric way after pressure or volume overload, while the hearts of men tend to remodel in an eccentric pattern. The exact mechanism for these sex-related differences in HF remodeling of the heart is unclear, but certain biomarkers that differ in expression levels in men and woman and are linked to pathophysiological processes may provide a better understanding [7-11].

This study evaluated sex-specific association of CV risk factors and biomarkers with the development of HF and to what extent certain biomarkers could improve HF risk prediction in men and woman.

Baseline medical data were harmonized across and pooled from 4 different well-characterized community-based, longitudinal cohorts: the Framingham Heart Study (FHS) offspring cohort examination 6 (1995 to 1998), the Prevention of REnaL AND Vascular Endstage Disease (PREVEND) examination (1997 to 1998), the Multi-Ethnic Study of Atherosclerosis (MESA) examination 1 (2000 to 2002), and the Cardiovascular Health Study (CHS) examination 1 (1989 to 1990; 1992 to 1993). The well-defined primary endpoint in all these studies was the development of HF or death. Exclusion criteria were: <30 years of age, prevalent HF, missing clinical covariates, or unavailable follow-up data. The following biomarkers were included: BNP/NTpro-BNP, cTns (cTnT or cTnI), PAI-1, D-dimer, fibrinogen, CRP, galectin-3, sST2, cystatin-C, and urinary-tot creatinine ratio (UACR). All biomarkers were measured in at least 3 cohorts, except the marker sST2, which was measured in only 2 cohorts. The clinical variables used in sex-specific clinical models were: age, smoking, diabetes mellitus, hypertension, BMI, atrial fibrillation, MI, and the presence of left ventricular hypertrophy/left bundle branch block. Of the 22756 participants included in this study, 12087 (53.1%) were women, and 10669 (46.9%) were men. The median follow-up in women was 12.6 years (11.6-13.6 years) and in men 12.4 years (9.7-13.1 years).

Main results


Using data from 4 pooled cohorts to determine sex-specific associations of biomarkers and CV risk factors with incidence HF revealed a strong but similar association among women and men.


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