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VOLUME 12 NUMBER 1 • JULY 2015
Also, a number of studies suggested a relationship between
serum homocysteine levels and the presence of coronary artery
disease in women, but not in men.
14
Therefore, it represents a
stronger atherogenic factor in women than in men.
16
Other
studies however did not identify homocysteine as a significant
factor in predicting statistical risk of coronary heart disease after
adjustment for traditional risk factors, even though they found a
positive correlation between this biomarker and ischaemic heart
disease.
38
Nevertheless, the latest European guideline on cardiovascular
disease prevention in clinical practice states that homocysteine
may be measured as part of a refined risk assessment in patients
with an unusual or moderate CVD risk profile (class IIB, level B).
11
The measurement of serum homocysteine levels is not part of the
routine screening process for cardiovascular risk assessment.
11
Other markers
Natriuretic peptides
The Framingham Offspring study showed that 10 elevated
biomarkers, and high B-type natriuretic peptides (BNP) indicated
cardiovascular risk.
39
On the other hand, the Swedish Malmö diet
and cancer cohort showed that only BNP and mid-region pro-
adenomedulin levels were associated with a doubled cardiovascular
risk.
40
The 2012 ESC guidelines for the management of heart failure
revealed that BNP, N-terminal pro B-type natriuretic peptide
(NT-proBNP) and mid-regional pro-atrial natriuretic peptide
(MR-proANP) levels showed usefulness in detecting heart failure
patients, a differential diagnosis of dyspneoa and risk stratification.
41
The KORA study included 1 005 women and men aged between
25 and 75 years. The goal of this study was to determine the
variation in the NT-proBNP and BNP levels in a 10-year period. They
reported a strong correlation between gender, age and plasma
levels of natriuretic peptides. Both NT-proBNP and BNP serum
concentrations recorded an elevation during the follow-up period,
especially in women.
42
However, it has been shown that a BNP value
that exceeds 500 pg/ml represents a stronger predictor of death in
women than men with heart failure.
43
Growth-differentiation factor-15 (GDF-15) is a novel biomarker
under investigation, which is synthesised in ischaemic myocytes.
There is evidence that it strongly indicates an increased risk of
cardiovascular death.
44
Conclusion
Despite the use of these novel cardiovascular risk factors, the
presence of hypertension, diabetes, physical inactivity and
inflammatory markers remain the most potent cardiovascular risk
factors in women, regardless of age. Novel cardiovascular risk
factors may play a decisive role in the early diagnosis of ischaemic
heart disease, especially in women with suspected myocardial
ischaemia, but without electrocardiographic, echocardiographic
or angiographic findings. However, their routine measurement is
difficult to implement. The guidelines regarding coronary artery
disease in women could suggest the determination/ evaluation of
these novel cardiovascular risk factors when a differential diagnosis
should be considered.
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