A groundbreaking study published in the New England Journal of Medicine on Saturday has unveiled a new approach to routine blood tests, which could predict an individual’s 30-year risk of heart disease. This innovative method could revolutionize how doctors assess and manage cardiovascular risk.
Beyond cholesterol: Unveiling hidden risk factors
Traditionally, doctors have relied on blood tests that measure cholesterol levels, particularly focusing on LDL or “bad” cholesterol, to evaluate cardiovascular risk. However, experts argue that this approach overlooks significant and often silent risk factors.
“We have other biomarkers that tell us about other kinds of biological problems our patients who are destined to have cardiovascular disease are likely to have,” said Dr. Paul Ridker, lead study author and director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in Boston.
Key biomarkers identified
The study, led by Ridker and his team, identified two additional critical markers: lipoprotein (a) or Lp(a), a type of fat in the blood, and an indicator of inflammation. These markers were found to be crucial predictors of heart attack, stroke, and coronary heart disease.
Extensive research and presentation
The findings were also presented at the European Society of Cardiology Congress 2024 in London on the same day. The researchers analyzed data from nearly 30,000 U.S. women who participated in the Women’s Health Study. The participants, who were on average 55 years old when they enrolled between 1992 and 1995, were followed for 30 years. During this period, about 13% (roughly 3,600 women) experienced a heart attack, stroke, underwent surgery for a narrowed or blocked artery, or died from heart disease.
Although the research focused on women, Dr. Ridker emphasized that the findings likely apply to men as well. He noted that the focus on women was intentional, stating, “This is a largely preventable disease, but women tend to be under-treated and under-diagnosed.”
Predictive power of combined markers
At the beginning of the study, all participants underwent blood tests to measure LDL cholesterol, Lp(a), and C-reactive protein (CRP) levels, a marker of inflammation. These measurements, individually and collectively, were found to predict a woman’s heart health over the next three decades.
Women with the highest levels of LDL cholesterol had a 36% higher risk for heart disease compared to those with the lowest levels. Elevated Lp(a) levels indicated a 33% increased risk, while high CRP levels were associated with a 70% higher risk. When considering all three markers together, women with the highest levels were 1.5 times more likely to suffer a stroke and over three times more likely to develop coronary heart disease over the next 30 years compared to those with the lowest levels.
“All three represent different biological processes. They tell us why someone is actually at risk,” explained Dr. Ridker.
Early intervention: A key to prevention
Traditional risk factors for heart disease include obesity, diabetes, high blood pressure, and high cholesterol levels. However, testing for Lp(a) and CRP can uncover less obvious risk factors.
“You can have no traditional risk factors and just by having that high Lp(a), you are at higher risk,” said Dr. Rachel Bond, system director of women’s heart health at Dignity Health in Arizona, who was not involved with the study.
This study highlights the potential of a simple blood test to significantly enhance the prediction and prevention of heart disease. By incorporating additional biomarkers such as Lp(a) and CRP, doctors can gain a more comprehensive understanding of an individual’s cardiovascular risk, paving the way for more effective early interventions.
