Scientific reports, 10 2 2025 Sex-based differences in biomarker trajectories in acute coronary syndrome patients from the BIOMArCS study. Gärtner C, Haaf MET, Akkerhuis KM, Oemrawsingh RM, van Schaik RH, de Rijke YB, Kardys I, Appelman Y, Boersma E
Acute coronary syndrome (ACS) presents sex-based differences in pathophysiology. Variations in biomarker patterns post-ACS, reflecting myocardial injury, vascular inflammation, and remodeling, may indicate critical differences in cardiovascular disease mechanisms and outcomes. We analyzed biomarker patterns in 787 patients (22% females) from the BIOMArCS study, all without re-ACS during the study period. We tracked levels of hs-cTnT, NT-proBNP, hs-CRP, GDF-15, and additional biomarkers in a subcohort of 191 patients over one year. Serial blood samples were collected to compare acute-phase (first month after ACS) and stabilized-phase (2-12 months post-ACS) biomarker trajectories between sexes, adjusting for age, BMI, and kidney function using linear mixed-effects models. Females showed significantly lower hs-cTnT levels (mean 386 pg/mL versus 559 pg/mL in males, p = 0.002 acute phase; 8.5 pg/mL versus 10.8 pg/mL, p < 0.001 at 180 days). NT-proBNP levels were higher in females (mean 70 pmol/L vs. 47 pmol/L, p < 0.001 acute phase; 30 pmol/L vs. 19 pmol/L, p < 0.001 at 180 days). Hs-CRP levels were also elevated in females (mean 1.8 mg/L vs. 1.5 mg/L, p = 0.02 at 180 days). Galectin-3 levels remained higher in females (22.8 ng/mL vs. 18.6 ng/mL, p = 0.03). This study provides the first comprehensive analysis of sex-specific biomarker trajectories following ACS. Distinct differences in hs-cTnT, NT-proBNP, and inflammatory markers suggest that sex-specific diagnostic thresholds and personalized treatment strategies after ACS may be warranted, although their clinical value still needs confirmation in larger prospective studies.
