Severity of stable coronary artery disease and its biomarkers differ between men and women undergoing angiography


      • We examine sex differences in the severity of coronary artery disease (CAD).
      • More severe CAD is observed in men.
      • Sex differences exist in CAD biomarker levels.
      • Biomarkers of CAD associate with the severity of CAD similarly in men and women.



      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.


      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.


      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.


      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.


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