Sex-Based Differences in Cardiometabolic Biomarkers.
Few data are available comparing cardiovascular disease (CVD) biomarker profiles between women and men in the general population. We analyzed sex-based differences in multiple biomarkers reflecting distinct pathophysiological pathways, accounting for differences between women and men in CVD risk factors, body composition, and cardiac morphology.



A cross-sectional analysis was performed using data from the Dallas Heart Study, a multiethnic population-based study. Associations between sex and 30 distinct biomarkers representative of 6 pathophysiological categories were evaluated using multivariable linear regression adjusting for age, race, traditional CVD risk factors, kidney function, insulin resistance, MRI and dual-energy x-ray absorptiometry measures of body composition and fat distribution, and left ventricular mass.



After excluding participants with CVD, the study population included 3439 individuals, mean age 43 years, 56% women, and 52% black. Significant sex-based differences were seen in multiple categories of biomarkers, including lipids, adipokines, and biomarkers of inflammation, endothelial dysfunction, myocyte injury and stress, and kidney function. In fully adjusted models, women had higher levels of high-density lipoprotein cholesterol and high-density lipoprotein particle concentration, leptin, d-dimer, homoarginine, and N-terminal pro B-type natriuretic peptide, and lower levels of low-density lipoprotein cholesterol, adiponectin, lipoprotein-associated phospholipase A2 mass and activity, monocyte chemoattractant protein-1, soluble endothelial cell adhesion molecule, symmetrical dimethylarginine, asymmetrical dimethylarginine, high-sensitivity troponin T, and cystatin C.



Biomarker profiles differ significantly between women and men in the general population. Sex differences were most apparent for biomarkers of adiposity, endothelial dysfunction, inflammatory cell recruitment, and cardiac stress and injury. Future studies are needed to characterize whether pathophysiological processes delineated by these biomarkers contribute to sex-based differences in the development and complications of CVD.
From Departments of Medicine (J.L., M.S., D.K.M., M.O.G., I.N., J.D.B., A.K., A.R., J.A.d.L.) and Clinical Sciences (C.R.A., D.K.M., J.D.B.), UT Southwestern Medical Center, Dallas, TX; Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Norway (T.O.); Department of Clinical Pharmacology and Toxicology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany (D.A.); and Department of Cardiovascular Medicine, University of Oxford, United Kingdom (D.A.).
Jeanney
J
Lew
From Departments of Medicine (J.L., M.S., D.K.M., M.O.G., I.N., J.D.B., A.K., A.R., J.A.d.L.) and Clinical Sciences (C.R.A., D.K.M., J.D.B.), UT Southwestern Medical Center, Dallas, TX; Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Norway (T.O.); Department of Clinical Pharmacology and Toxicology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany (D.A.); and Department of Cardiovascular Medicine, University of Oxford, United Kingdom (D.A.).
Monika
M
Sanghavi
From Departments of Medicine (J.L., M.S., D.K.M., M.O.G., I.N., J.D.B., A.K., A.R., J.A.d.L.) and Clinical Sciences (C.R.A., D.K.M., J.D.B.), UT Southwestern Medical Center, Dallas, TX; Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Norway (T.O.); Department of Clinical Pharmacology and Toxicology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany (D.A.); and Department of Cardiovascular Medicine, University of Oxford, United Kingdom (D.A.).
Colby R
CR
Ayers
From Departments of Medicine (J.L., M.S., D.K.M., M.O.G., I.N., J.D.B., A.K., A.R., J.A.d.L.) and Clinical Sciences (C.R.A., D.K.M., J.D.B.), UT Southwestern Medical Center, Dallas, TX; Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Norway (T.O.); Department of Clinical Pharmacology and Toxicology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany (D.A.); and Department of Cardiovascular Medicine, University of Oxford, United Kingdom (D.A.).
Darren K
DK
McGuire
From Departments of Medicine (J.L., M.S., D.K.M., M.O.G., I.N., J.D.B., A.K., A.R., J.A.d.L.) and Clinical Sciences (C.R.A., D.K.M., J.D.B.), UT Southwestern Medical Center, Dallas, TX; Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Norway (T.O.); Department of Clinical Pharmacology and Toxicology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany (D.A.); and Department of Cardiovascular Medicine, University of Oxford, United Kingdom (D.A.).
Torbjørn
T
Omland
From Departments of Medicine (J.L., M.S., D.K.M., M.O.G., I.N., J.D.B., A.K., A.R., J.A.d.L.) and Clinical Sciences (C.R.A., D.K.M., J.D.B.), UT Southwestern Medical Center, Dallas, TX; Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Norway (T.O.); Department of Clinical Pharmacology and Toxicology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany (D.A.); and Department of Cardiovascular Medicine, University of Oxford, United Kingdom (D.A.).
Dorothee
D
Atzler
From Departments of Medicine (J.L., M.S., D.K.M., M.O.G., I.N., J.D.B., A.K., A.R., J.A.d.L.) and Clinical Sciences (C.R.A., D.K.M., J.D.B.), UT Southwestern Medical Center, Dallas, TX; Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Norway (T.O.); Department of Clinical Pharmacology and Toxicology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany (D.A.); and Department of Cardiovascular Medicine, University of Oxford, United Kingdom (D.A.).
Maria O
MO
Gore
From Departments of Medicine (J.L., M.S., D.K.M., M.O.G., I.N., J.D.B., A.K., A.R., J.A.d.L.) and Clinical Sciences (C.R.A., D.K.M., J.D.B.), UT Southwestern Medical Center, Dallas, TX; Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Norway (T.O.); Department of Clinical Pharmacology and Toxicology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany (D.A.); and Department of Cardiovascular Medicine, University of Oxford, United Kingdom (D.A.).
Ian
I
Neeland
From Departments of Medicine (J.L., M.S., D.K.M., M.O.G., I.N., J.D.B., A.K., A.R., J.A.d.L.) and Clinical Sciences (C.R.A., D.K.M., J.D.B.), UT Southwestern Medical Center, Dallas, TX; Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Norway (T.O.); Department of Clinical Pharmacology and Toxicology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany (D.A.); and Department of Cardiovascular Medicine, University of Oxford, United Kingdom (D.A.).
Jarett D
JD
Berry
From Departments of Medicine (J.L., M.S., D.K.M., M.O.G., I.N., J.D.B., A.K., A.R., J.A.d.L.) and Clinical Sciences (C.R.A., D.K.M., J.D.B.), UT Southwestern Medical Center, Dallas, TX; Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Norway (T.O.); Department of Clinical Pharmacology and Toxicology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany (D.A.); and Department of Cardiovascular Medicine, University of Oxford, United Kingdom (D.A.).
Amit
A
Khera
From Departments of Medicine (J.L., M.S., D.K.M., M.O.G., I.N., J.D.B., A.K., A.R., J.A.d.L.) and Clinical Sciences (C.R.A., D.K.M., J.D.B.), UT Southwestern Medical Center, Dallas, TX; Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Norway (T.O.); Department of Clinical Pharmacology and Toxicology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany (D.A.); and Department of Cardiovascular Medicine, University of Oxford, United Kingdom (D.A.).
Anand
A
Rohatgi
From Departments of Medicine (J.L., M.S., D.K.M., M.O.G., I.N., J.D.B., A.K., A.R., J.A.d.L.) and Clinical Sciences (C.R.A., D.K.M., J.D.B.), UT Southwestern Medical Center, Dallas, TX; Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Norway (T.O.); Department of Clinical Pharmacology and Toxicology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany (D.A.); and Department of Cardiovascular Medicine, University of Oxford, United Kingdom (D.A.). james.delemos@utsouthwestern.edu.
James A
JA
de Lemos
D000328:Adult; D015415:Biomarkers / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors
D015415:Biomarkers
biomarkers; body composition; cardiovascular diseases; menopause; sex; women