title: Severity of stable coronary artery disease and its biomarkers differ between men and women undergoing angiography.
abstract: BACKGROUND
  Coronary artery disease (CAD) affects both men and women. Cardiovascular biomarkers have been suggested to relate to CAD severity, but data on sex-specificity is scarce. Therefore, we investigated the association of established biomarkers with the severity of CAD in stable patients undergoing coronary angiography in a sex-specific manner.
  
  
  METHODS
  We studied stable patients undergoing coronary angiography and measured CAD severity by SYNTAX score and biomarker levels (N-terminal pro-brain natriuretic peptide (NT pro-BNP), high-sensitivity CRP (hsCRP), cystatin C (CysC), myeloperoxidase (MPO), high-sensitivity troponin I (hsTnI) and von Willebrand factor (VWF)). We tested for sex differences in SYNergy between percutaneous coronary intervention with TAXUS™ and cardiac surgery (SYNTAX) scores and biomarker levels using multivariable ANCOVA. We investigated the association of biomarker levels with SYNTAX score in a multivariable linear regression with interaction terms for sex.
  
  
  RESULTS
  We analysed data on 460 men and 175 women. SYNTAX scores were significantly lower in women (9.99 points vs. 11.88 points). Univariably, hsCRP and hsTnI levels were significantly associated with SYNTAX scores (both β 2.5). In multivariable analysis only hsCRP associated with SYNTAX score (β 1.9, p = 0.009). Sex did not modify the association of biomarkers with SYNTAX score.
  
  
  CONCLUSIONS
  CAD severity as quantified by SYNTAX score is lower in women than men based on coronary angiography. The association of biomarkers with CAD severity did not differ between the sexes.
authors: Laboratory of Experimental Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, The Netherlands; ICIN-Netherlands Heart Institute, Utrecht, The Netherlands.
authors: Crystel M
authors: CM
authors: Gijsberts
authors: Laboratory of Experimental Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, The Netherlands.
authors: Aisha
authors: A
authors: Gohar
authors: Laboratory of Experimental Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, The Netherlands.
authors: Guilielmus H J M
authors: GH
authors: Ellenbroek
authors: Laboratory of Experimental Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, The Netherlands.
authors: Imo E
authors: IE
authors: Hoefer
authors: Laboratory of Experimental Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, The Netherlands; ICIN-Netherlands Heart Institute, Utrecht, The Netherlands; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University Heart Centre, National University Health System, Singapore.
authors: Dominique P V
authors: DP
authors: de Kleijn
authors: Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands; Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom.
authors: Folkert W
authors: FW
authors: Asselbergs
authors: Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, The Netherlands.
authors: Hendrik M
authors: HM
authors: Nathoe
authors: Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, The Netherlands.
authors: Pierfrancesco
authors: P
authors: Agostoni
authors: Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, The Netherlands.
authors: Saskia Z H
authors: SZ
authors: Rittersma
authors: Laboratory of Experimental Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, The Netherlands.
authors: Gerard
authors: G
authors: Pasterkamp
authors: Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
authors: Yolande
authors: Y
authors: Appelman
authors: Laboratory of Experimental Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, The Netherlands. Electronic address: H.M.denRuijter-2@umcutrecht.nl.
authors: Hester M
authors: HM
authors: den Ruijter
mesh_terms: D000368:Aged; D018070:Biological Specimen Banks; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000000981:diagnostic imaging*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors
chemical_list: D015415:Biomarkers
keywords: Biomarkers; Coronary angiography; Epidemiology; Sex