Women’s heart disease risks and the need to start taking preventive medications should be assessed in their 30s, not long after menopause as is now the norm, researchers said.
Presenting their findings at the European Society of Cardiology annual meeting in London, they said the study showed for the first time that a simple blood test makes it possible to estimate a woman’s risk of developing cardiovascular disease over the next three decades.
“This is good for patients first and foremost, but it’s also important information for (manufacturers of) cholesterol-lowering drugs, anti-inflammatory drugs, and lipoprotein-lowering drugs,” said Dr. Paul Ridker of Brigham and Women’s Hospital in Boston.
Current guidelines “suggest that doctors generally should not prescribe preventive treatments to women until they are in their 60s or 70s,” Ridker added. “These new data… clearly show that our guidelines need to change.”
“We have to look beyond discussions about five or 10-year risks,” he added.
The 27,939 participants in the long-term Women’s Health Initiative study had blood tests between 1992 and 1995 to measure their levels of low-density lipoprotein (LDL), or “bad” cholesterol, as part of their regular health care. There’s also a good type of cholesterol called high-density lipoprotein, or HDL.
They also underwent high-sensitivity C-reactive protein (CRP) testing, a test for inflammation in blood vessels, and lipoprotein A, a genetically determined type of fat.
Dangers of bad cholesterol
Compared with the risks for women who had the lowest levels on each test, the risk of cardiovascular events, such as heart attacks or strokes, over the next 30 years was 36% higher for women with the highest levels of LDL cholesterol, 70% higher for women with the highest levels of high-sensitivity C-reactive protein, and 33% higher for women with the highest levels of lipoprotein (a).
Women who scored highest on all three tests were 2.6 times more likely to have a cardiovascular event and 3.7 times more likely to have a stroke over the next three decades, a report in The New England Journal of Medicine found.
“The three tests are completely independent of each other, and they show us different biological problems that each woman faces individually,” Ridker said.
“The treatments we might use to address elevated levels in each of the biomarkers are quite different, and doctors can now specifically target the biomarker in a particular person,” he added.
Although drugs to lower LDL cholesterol and high-sensitivity C-reactive protein are widely available, including statins and certain pills for high blood pressure and heart failure, drugs to lower Lp(a) are still under development by companies including Novartis, Amgen, Eli Lilly and London-based Silence Therapeutics.
Lifestyle changes, such as exercise and quitting smoking, may be helpful in some cases.
“This is a global problem,” Ridker added. “We need a global test for high-sensitivity C-reactive protein … and for lipoprotein (a) just as we do a global test for cholesterol.”