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Sex-differences in circulating biomarkers during acute myocardial infarction : An analysis from the SWEDEHEART registry

Eggers, Kai M. ; Lindhagen, Lars ; Baron, Tomasz ; Erlinge, David LU orcid ; Hjort, Marcus ; Jernberg, Tomas ; Johnston, Nina ; Marko-Varga, György LU ; Rezeli, Melinda LU orcid and Spaak, Jonas , et al. (2021) In PLoS ONE 16(4 April).
Abstract

Background Sex-differences in the pathobiology of myocardial infarction are well established but incompletely understood. Improved knowledge on this topic may help clinicians to improve management of men and women with myocardial infarction. Methods In this registry-based cohort study (SWEDEHEART), we analyzed 175 circulating biomarkers reflecting various pathobiological axes in 856 men and 243 women admitted to Swedish coronary care units because of myocardial infarction. Two multimarker panels were applied (Proximity Extension Assay [Olink Bioscience], Multiple Reaction Monitoring mass spectrometry). Lasso analysis (penalized logistic regression), multiple testing-corrected Mann- Whitney tests and Cox regressions were used to assess... (More)

Background Sex-differences in the pathobiology of myocardial infarction are well established but incompletely understood. Improved knowledge on this topic may help clinicians to improve management of men and women with myocardial infarction. Methods In this registry-based cohort study (SWEDEHEART), we analyzed 175 circulating biomarkers reflecting various pathobiological axes in 856 men and 243 women admitted to Swedish coronary care units because of myocardial infarction. Two multimarker panels were applied (Proximity Extension Assay [Olink Bioscience], Multiple Reaction Monitoring mass spectrometry). Lasso analysis (penalized logistic regression), multiple testing-corrected Mann- Whitney tests and Cox regressions were used to assess sex-differences in the concentrations of these biomarkers and their implications on all-cause mortality and major adverse events (median follow-up up to 6.6 years). Results Biomarkers provided a very high discrimination between both sexes, when considered simultaneously (c-statistics 0.972). Compared to women, men had higher concentrations of six biomarkers with the most pronounced differences seen for those reflecting atherogenesis, myocardial necrosis and metabolism. Women had higher concentrations of 14 biomarkers with the most pronounced differences seen for those reflecting activation of the reninangiotensin- aldosterone axis, inflammation and for adipokines. There were no major variations between sexes in the associations of these biomarkers with outcome. Conclusions Severable sex-differences exist in the expression of biomarkers in patients with myocardial infarction. While these differences had no impact on outcome, our data suggest the presence of various sex-related pathways involved in the development of coronary atherosclerosis, the progression to plaque rupture and acute myocardial damage, with a greater heterogeneity in women.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
PLoS ONE
volume
16
issue
4 April
article number
e0249830
publisher
Public Library of Science (PLoS)
external identifiers
  • scopus:85104111503
  • pmid:33831096
ISSN
1932-6203
DOI
10.1371/journal.pone.0249830
language
English
LU publication?
yes
id
015a0ed5-af0c-4e49-85e8-a440cd23ee2c
date added to LUP
2021-04-26 10:34:01
date last changed
2024-06-15 10:25:42
@article{015a0ed5-af0c-4e49-85e8-a440cd23ee2c,
  abstract     = {{<p>Background Sex-differences in the pathobiology of myocardial infarction are well established but incompletely understood. Improved knowledge on this topic may help clinicians to improve management of men and women with myocardial infarction. Methods In this registry-based cohort study (SWEDEHEART), we analyzed 175 circulating biomarkers reflecting various pathobiological axes in 856 men and 243 women admitted to Swedish coronary care units because of myocardial infarction. Two multimarker panels were applied (Proximity Extension Assay [Olink Bioscience], Multiple Reaction Monitoring mass spectrometry). Lasso analysis (penalized logistic regression), multiple testing-corrected Mann- Whitney tests and Cox regressions were used to assess sex-differences in the concentrations of these biomarkers and their implications on all-cause mortality and major adverse events (median follow-up up to 6.6 years). Results Biomarkers provided a very high discrimination between both sexes, when considered simultaneously (c-statistics 0.972). Compared to women, men had higher concentrations of six biomarkers with the most pronounced differences seen for those reflecting atherogenesis, myocardial necrosis and metabolism. Women had higher concentrations of 14 biomarkers with the most pronounced differences seen for those reflecting activation of the reninangiotensin- aldosterone axis, inflammation and for adipokines. There were no major variations between sexes in the associations of these biomarkers with outcome. Conclusions Severable sex-differences exist in the expression of biomarkers in patients with myocardial infarction. While these differences had no impact on outcome, our data suggest the presence of various sex-related pathways involved in the development of coronary atherosclerosis, the progression to plaque rupture and acute myocardial damage, with a greater heterogeneity in women.</p>}},
  author       = {{Eggers, Kai M. and Lindhagen, Lars and Baron, Tomasz and Erlinge, David and Hjort, Marcus and Jernberg, Tomas and Johnston, Nina and Marko-Varga, György and Rezeli, Melinda and Spaak, Jonas and Lindahl, Bertil}},
  issn         = {{1932-6203}},
  language     = {{eng}},
  number       = {{4 April}},
  publisher    = {{Public Library of Science (PLoS)}},
  series       = {{PLoS ONE}},
  title        = {{Sex-differences in circulating biomarkers during acute myocardial infarction : An analysis from the SWEDEHEART registry}},
  url          = {{http://dx.doi.org/10.1371/journal.pone.0249830}},
  doi          = {{10.1371/journal.pone.0249830}},
  volume       = {{16}},
  year         = {{2021}},
}