In this article:
- New research found that three items in a blood panel can predict the 30-year risk of cardiovascular events in women
- Study participants with high levels of C-reactive protein (CRP), low-density lipoprotein cholesterol, or lipoprotein(a) [LP(a)] had a 33% to 70% greater risk of a cardiovascular event
- These risk factors are modifiable with lifestyle modifications and medications
- CRP and LP(a) could be added to screening guidelines to identify people who need earlier and more aggressive interventions
New research from Mass General Brigham shows that three items on blood panel — high-sensitivity C-reactive protein (hsCRP) and lipoprotein(a) or LP(a), in addition to low-density lipoprotein cholesterol (LDL-C) — can predict a woman’s 30-year risk of death from a cardiovascular event better than current screening guidelines.
“Cardiovascular disease remains underdiagnosed and undertreated in women, and that just has to change,” says Paul Ridker, MD, a Brigham and Women’s cardiologist and researcher. “All healthcare providers need to recognize that prevention has to start in people’s 30s and 40s, not their 60s and 70s. And this study is showing us the path to get there.”
Dr. Ridker says the study’s findings should lead to the addition of the hsCRP and LP(a) biomarkers to universal screening guidelines. In patients with elevated levels, earlier and more aggressive intervention is warranted, including lifestyle modifications and new targeted medications.
Data Support New Approach to Screening for Heart Disease
Current screening guidelines focus on HDL and LDL cholesterol, blood glucose, triglycerides, body mass index, and family history of heart disease. Based on that information, providers calculate a risk score — which Dr. Ridker argues is outdated. The approach often doesn’t identify a woman at risk until she is 65 or 70 years old.
Furthermore, Dr. Ridker says several of these risk factors are not modifiable. The factors that can be changed don’t necessarily change the risk of cardiovascular events.
“Why would you wait until you’re 65 years old to initiate diet, exercise, smoking cessation, potentially taking a statin and other life-saving drugs, which should have been initiated 25, 30 years ago?” Dr. Ridker says. “But that is what our screening guidelines tell us to do. We’re trying to explode that entire paradigm.”
The new study, published in the New England Journal of Medicine, used the Women’s Health Study to follow the heart health of 27,939 women over 30 years. Every woman in the study had a baseline blood test in 1993 that included many different measurements. Then, the study followed participants for decades and recorded the first major cardiovascular events.
The researchers analyzed which measurements were most associated with cardiovascular events, identifying three important markers.
The Association of hsCRP and Heart Disease
The strongest predictor of a future cardiovascular event was hsCRP, an indicator of systemic inflammation. Women with the highest levels of hsCRP had a 70% higher risk of a major cardiovascular event.
Taking steps to lower inflammation earlier in life can help reduce elevated hsCRP and related risk of a future cardiovascular event. For example, exercise and a diet rich in plant-based foods can help lower hsCRP.
Certain targeted anti-inflammatory therapies also can be effective. For example, the U.S. Food and Drug Administration recently approved the first targeted anti-inflammatory drug to prevent heart disease by reducing inflammation: low-dose colchicine. The inexpensive medication has been shown to lower the risk of a heart attack or stroke by 25% to 30%.
Dr. Ridker is currently involved in a trial testing another novel anti-inflammatory drug that could help lower the risk of heart attack and stroke in patients who can’t take colchicine. The ZEUS trial (Ziltivekimab Cardiovascular Outcomes Study) is assessing whether ziltivekimab, an interleukin-6 inhibitor, can reduce rates of cardiovascular events in people with chronic kidney disease.
LDL-C Is a Modifiable Risk Factor
LDL-C is measured in routine blood tests and has long been known to be a risk factor for cardiovascular disease. In Dr. Ridker’s study, women with the highest levels of LDL-C had a 36% greater risk of having a cardiovascular event.
As with hsCRP, LCL-C is controllable to some degree. “We have overwhelming evidence that if we reduce LDL-C with diet, exercise, and statins or lipid-lowering drugs, we can lower the risk of cardiovascular events,” Dr. Ridker says.