Could a blood test help predict cardiovascular risk in women?

• Cardiovascular disease is the leading cause of death in women globally.
• There have historically been disparities in diagnosing cardiovascular disease in women as they may have no or different symptoms than men.
• Researchers from Brigham and Women’s Hospital found measuring three different biological blood markers can better predict a woman’s risk of having a major cardiovascular event over the next 30 years compared to measuring only one biomarker.

“Younger women typically are concerned about other medical issues such as risks for breast cancer, but heart attack and stroke are major issues for women, as for men, and we need to intervene and start prevention much earlier,” Paul M Ridker, MD, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital told Medical News Today. “Sadly, heart disease in women remains under-diagnosed and under-treated.”

Ridker is the lead author of a new study recently published in the New England Journal of Medicine that that found measuring three different biological blood biomarkers can better predict a woman’s risk of having a major cardiovascular event, such as a heart attack or stroke, over the next 30 years compared to measuring only one biomarker.

For this study, researchers analyzed data from the Women’s Health Study (WHS), funded by the National Institutes of Health (NIH). Since 1993, the study has followed female health professionals ages 45 years and older.

The primary endpoint of the Women’s Health Study was a participant having their first major cardiovascular event, such as a heart attack, stroke, or death from heart-related issues.

“We already have universal screening for LDL or ‘bad’ cholesterol,” Ridker explained. “What we are arguing here is that we should also have universal screening for hsCRP — which is a marker of inflammation in the arteries which is a major problem — and for Lp(a), which is another lipid marker.”

“The three each represent modifiable and different biologic processes, each of which can be responsible for developing heart disease,” he continued.

“The era of ‘one size fits all’ is over and we need to move forward to [address] the specific unique biologic issues each of our patients suffers from. But physicians do not treat with they do not measure, so each of these needs to be evaluated. All are simple, widely available, inexpensive blood tests,” noted Ridker.

When analyzing and comparing the data, Ridker and his team found that the percentage of risk of having a major cardiovascular event increased to:

• 70% in women with the highest levels of hsCRP
• 36% in women with the highest levels of LDL-C
• 33% in women with the highest levels of Lp(a).

“We were astonished to see that inflammation assessed by hsCRP is associated with risks 30 years down the road — it (tells) us something profound about how our immune system can drive atherosclerotic disease. Moreover, we now have hard evidence that lowering inflammation can reduce rates of heart attack and stroke and the U.S. FDA just last year approved the first targeted anti-inflammatory treatment for heart disease, low-dose colchicine, exactly for this purpose.”

“Yet even though it conveys the greatest risk, hsCRP is the biomarker doctors are least likely to measure of the three. That has to change,“ he emphasized.

Scientists also found that female study participants who had raised levels of all three biomarkers were 2.6 times more likely to have a major adverse cardiovascular event, and 3.7 times more likely to have a stroke over the next 30 years.

“Each biomarker adds to the others — if a woman is unlucky enough to have all three elevated, risks are substantially high,” Ridker explained.

“But if we catch this early in life, we can institute preventive therapies now instead of waiting until she is in her late 60’s or 70’s which is how things are done now. We should be screening in our 30’s and 40’s to give ample time to institute preventive therapies to include dietary discretion, regular exercise, smoking cessation, and where needed drug therapy,” he added.

“We can no longer simply be concerned with five or 10 year risks if we are going to prevent heart disease in women — we need to address the long game and think about lifetime risks. As proven here, a simple set of three easily obtained inexpensive blood tests can go a long way toward directing doctors to treat the specific issue that puts their female patients at risk. The time to change our guidelines is now — in Europe, universal screening at a young age has already largely been adopted, so why has it not been done here?”

– Paul M Ridker, MD

MNT also spoke with Nicole Weinberg, MD, a board-certified cardiologist at Providence Saint John’s Health Center in Santa Monica, CA, about this study. Weinberg was not involved in this research.

“They are looking at testing people more broadly for lipoprotein [a], which is a new risk factor that we’ve been looking at quite regularly in patients now,” she commented.

“Not only is it considered to be a risk factor for coronary artery disease, but it’s a risk factor for certain valvular heart disease, and it is a test that is very elucidating for people that are at risk for any sort of cardiovascular condition. So to fold that into a woman’s arsenal for preventative testing, I think is extremely important,” Weinberg continued.

“I think that the more frequent use of these advanced lipid tests is going to be critical for people in terms of figuring out what their risks are moving forward and doing their very best to identify if they are at increased risk, and then do whatever they have to do to modify that risk will be really important,” said Weinberg.

“[Moreover,] I think it just highlights the fact that when you’re looking at cardiovascular risk factors, it’s a pie. There’s a lot of pieces of the pie and it’s somewhat unclear how large each of those pieces are and how small, but it is important to identify what your risk factors are as young as possible, so that you can do your very best to attempt to modify those so that you don’t end up with a cardiovascular event,” she concluded.