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A new study has revealed that testing for three specific biomarkers in a woman’s bloodstream could help predict her risk of heart attack, stroke, or other cardiovascular issues later in life. The study, published in the New England Journal of Medicine on August 31, included nearly 28,000 participants and identified low-density lipoprotein (LDL) cholesterol, lipoprotein(a) [Lp(a)], and high-sensitivity C-reactive protein (CRP) as key indicators of future cardiovascular events.
Led by Dr. Paul Ridker, Director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital, the research emphasizes the need for early screenings. “Doctors do not treat what they do not measure,” said Ridker. “We need to start prevention much earlier and get these three biomarkers measured universally.”
The Importance of Early Screening
Cardiovascular disease is the leading cause of death among women in the U.S., with approximately 60 million affected. Standard screening currently focuses on LDL cholesterol, but Ridker and his team argue that adding tests for high-sensitivity CRP and Lp(a) would improve risk prediction. CRP indicates inflammation in the body, which can contribute to atherosclerosis, while Lp(a) is a genetically determined blood fat that increases heart attack risk.
The study tracked the participants’ biomarker levels over 30 years and found that women with elevated levels of these biomarkers were 2.6 times more likely to experience a major cardiovascular event. Women with the highest levels of high-sensitivity CRP had a 70% greater risk, while those with elevated LDL cholesterol and Lp(a) levels had 36% and 33% greater risk, respectively.
Inflammation, Cholesterol, and Cardiovascular Health
Chronic inflammation and high cholesterol are significant contributors to heart disease. High CRP levels, often linked to obesity or conditions like autoimmune diseases, reflect inflammation, a major factor in atherosclerosis. Elevated LDL cholesterol can lead to plaque buildup in arteries, restricting blood flow and increasing the risk of heart attack or stroke. Lp(a) is a cholesterol particle whose elevated levels are purely genetic and not influenced by lifestyle changes.
“LDL or ‘bad cholesterol’ is responsible for plaque buildup, making arteries narrower,” explained Dr. Tiffany Di Pietro, a cardiologist based in Florida. While elevated LDL cholesterol can result from poor diet or inactivity, Lp(a) levels cannot be managed through lifestyle changes. Roughly one in five people have elevated Lp(a) levels, though many remain unaware.
The Future of Cardiovascular Screening
In addition to measuring LDL cholesterol, CRP, and Lp(a), healthcare providers may also suggest other tests like Apolipoprotein B (ApoB) or imaging techniques such as coronary CT angiograms. These tools can help identify cardiovascular risk and guide personalized treatment strategies, such as prescribing cholesterol-lowering medications like statins or inflammation-reducing drugs like colchicine.
There are also medications in development to specifically target and lower Lp(a) levels, offering new hope for individuals with genetically elevated Lp(a).
Advocating for Better Heart Health
Despite the availability of these blood tests, CRP and Lp(a) are not commonly included in routine screenings. Both are affordable and simple to perform but often need to be requested by patients. Dr. Ridker urged patients to be proactive about their heart health by asking for these tests and focusing on lifestyle changes, including healthier diets, regular exercise, and smoking cessation.
“For patients with a family history of heart disease, knowing your Lp(a) levels is especially important,” said Dr. Anum Minhas, a cardiologist at Johns Hopkins School of Medicine. “Genetics may not be within your control, but many lifestyle factors are.”
Ultimately, the study stresses that cardiovascular risk increases earlier in life than previously thought, reinforcing the need for preventive efforts starting in a person’s 30s or 40s. Early detection of risk factors can help reduce the prevalence of heart disease and improve long-term outcomes for women.
