Klotho plasma levels are an independent predictorof mortality in women with acute coronary syndrome.

Alterations in plasma levels of the components of the mineral metabolism (MM) system are related to cardiovascular diseases. However, gender differences of the whole MM system in patients with acute coronary syndrome (ACS) have not been reported. Our objective was to analyse the potential differences on the prognostic role of MM in women suffering an ACS as compared to men. We included 1,230 patients with ACS and collected clinical data and plasma levels of MM components. Primary outcome was a composite of acute ischaemic events, heart failure and all-cause mortality. Secondary outcomes included each component separately. 282 patients (22.9%) were female. After 5.44 years of follow-up, primary outcome occurred in 28.0% women and 23.5% men, and death in 10.6% and 9.4% respectively. FGF23 was associated with primary outcome in both sexes, and calcidiol only in men (HR 1.04, CI95%1.00-1.03). Klotho levels are inversely related to all-cause mortality only in women (HR 0.80, CI95% 0.67-0.96), while calcidiol (HR 0.84, CI95%0.72-0.98) and FGF23 levels (HR 1.02 CI95%1.00-1.03) were predictors in men, highlighting a possible gender-specific prognostic biomarker. These results underline the importance of considering MM biomarkers in risk stratification and management of patients with acute coronary syndromes, with attention to gender differences.