New Blood Test Predicts Long-Term Heart Disease Risk in Women: Study

The findings supported by the National Institutes of Health (NIH), presented at the European Society of Cardiology Congress 2024, were published in the New England Journal of Medicine.

"We can't treat what we don't measure, and we hope these findings move the field closer to identifying even earlier ways to detect and prevent heart disease," said Paul M. Ridker, M.D., M.P.H., study author and director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital, Boston.

The study involved 27,939 US healthcare providers who participated in the Women's Health Study.

Women, who began the study between 1992 and 1995 at an average age of 55, were followed for 30 years.

During this period, 3,662 participants experienced a heart attack, stroke, surgery to restore circulation, or cardiovascular-related death.

Researchers evaluated how high-sensitivity CRP, low-density lipoprotein (LDL) cholesterol, and lipoprotein(a) (Lp(a))—a lipid partly made of LDL—individually and collectively predicted these events.

Participants were divided into five categories based on their levels of the three markers.

The study found that women with the highest LDL cholesterol levels had a 36% increased risk of heart disease compared to those with the lowest levels.

Those with the highest Lp(a) levels had a 33% increased risk, while those with the highest CRP levels faced a 70% increased risk.

When all three markers—LDL cholesterol, Lp(a), and CRP—were assessed together, women with the highest levels had more than a 1.5-times increased risk of stroke and more than a 3-times increased risk of coronary heart disease compared to those with the lowest levels.

The researchers suggest that similar results would likely be found in men.

"In recent years, we've learned more about how increased levels of inflammation can interact with lipids to compound cardiovascular disease risks," said Ahmed A.K. Hasan, M.D., Ph.D., a medical officer and program director at the National Heart, Lung, and Blood Institute (NHLBI). "This helps explain why lower levels are often better."

Immune cells, which help the body repair itself from wounds or infections, can also detect excess cholesterol in cells or react to plaque build-up by sending inflammatory signals.

This creates a hyperinflammatory environment where plaque can form, grow, or even rupture, leading to cardiovascular events.

The researchers emphasize the importance of primary prevention for optimal cardiovascular health.

This includes regular physical activity, a heart-healthy diet, stress management, and avoiding or quitting tobacco.

For those with increased risks, additional measures may include medication to lower cholesterol and/or reduce inflammation.

The study also highlights the long-term benefits of early life actions to support heart and vascular health, correlating with better health outcomes decades later.

LDL cholesterol, commonly measured by healthcare providers, can be treated with widely available therapies such as statins.

However, standard screening recommendations for Lp(a) and CRP can vary.

Some countries recommend Lp(a) screening, as elevated levels often result from inherited risks.

In regions without universal Lp(a) screening, like the US, physicians may order tests for individuals with heart disease or a family history of it.

Some therapies are available for those with elevated levels, and researchers are exploring new approaches to personalize and improve treatment options.

CRP testing also varies, often depending on a person's underlying risks or at the provider's discretion.

Colchicine, an anti-inflammatory therapy previously used for gout, was approved by the FDA in 2023 to reduce cardiovascular disease risks among people with atherosclerosis.

Additional anti-inflammatory therapies and approaches are under investigation.