Gender medicine in the evaluation of cardiovascular diseases: focus on cardiovascular biomarkers: A consensus document by the Study Group on Cardiac Biomarkers from the Italian Society of Clinical Biochemistry (SIBioC) and the European Ligand Assay Society (ELAS).

Many studies have demonstrated the crucial pathophysiological and clinical relevance to evaluate cardiac specific biomarkers (natriuretic peptides and cardiac troponins) for the diagnosis and risk prediction of cardiovascular diseases in the general population and in patients with cardiovascular diseases as well. However, some important pathophysiological aspects still need to be better clarified, such as the possible influence of the sex hormones on the circulating concentrations of cardiac biomarkers and therefore on the interpretation of changes in their circulating levels in healthy subjects and in patients with cardiovascular disease. The primary purpose of this document is to discuss the pathophysiological and clinical relevance of sex- and/or gender-related differences in circulating levels of cardiac biomarkers. In the first part of this document, the pathophysiological mechanisms related to age, sex, gonadal development and function (including pregnancy) will be discussed. In the second part, the pharmacological effects of sex hormone therapy will be discussed. Sex hormones can be prescribed to patients of both sexes as replacement therapy, for prevention or treatment. However, many transgender persons undergo treatment with gender-affirming hormone therapy in order to help aligning their physical traits and gender identity. Accordingly, the possible effect of sex steroid hormone administration on the circulating levels of cardiac-specific biomarkers will be discussed. The most recent studies confirm the pathophysiological hypothesis that the androgenic steroid hormones (particularly testosterone) are generally associated with higher levels of cardiac troponins. On the other hand, the administration of estrogenic steroid hormones (particularly estradiol) can stimulate the production and release of cardiac natriuretic hormones from cardiomyocytes. [ABSTRACT FROM AUTHOR]