Researchers from Brigham and Women’s Hospital in the United States of America revealed – in a pioneering study – that a single test can predict the risk of heart attacks and strokes during the following thirty years.
The test measures three indicators that can be reduced through early use of medications and lifestyle modifications in women at risk. The proposed test is performed through a single blood sample and once throughout life.
Three indicators
The study, published Aug. 31 in the New England Journal of Medicine, involved 27,939 American women who were in good health at the start of their study. The women’s levels of C-reactive protein, low-density lipoprotein (LDL) and lipoprotein A were measured in a blood sample taken when they enrolled in the study.
The main trial began in 1993 and has followed women over the age of 45 since then. The study followed women until they had their first adverse cardiovascular event such as a heart attack, stroke or death from a cardiovascular cause.
High-sensitivity C-reactive protein (HSCP) is a protein whose elevation indicates vasculitis. Its level is also elevated in various chronic disorders such as autoimmune diseases, malignant tumors, chronic wounds after injury, inflammatory conditions, and metabolic disorders.
Low-density lipoprotein (LDL) is the infamous fat that is associated with a higher risk of cardiovascular disease.
Lipoprotein A is a type of lipoprotein that runs in families and is a common risk factor for heart disease. The concentration of this protein is stable over time, so it is recommended to measure it once and not to repeat the test.
“Doctors can’t treat what they don’t measure,” said study lead author Paul Ridker, MD, director of the Center for Cardiovascular Prevention at Brigham and Women’s Hospital, who presented the study findings at the 2024 European Society of Cardiology (ESC) Congress in London. “To provide the best care for our patients, we need a comprehensive screening for inflammation, cholesterol and Lp A, and we need it now. By doing so, we can target our treatments to the specific biological needs of each patient, fulfilling our long-standing hope of providing truly personalized preventive care.”
Warning for women
Although CRP was the strongest predictor of the three, they were all very important. Women with high levels of all three were 2.6 times more likely to have a major adverse cardiovascular event. The relationship was even stronger for stroke, with women with the highest levels 3.7 times more likely to have a stroke over the next 30 years.
“These data should be a wake-up call for women,” said study co-author Dr. Julie Bering, principal investigator of the Women’s Health Study and an epidemiologist in the Department of Preventive Medicine at Brigham and Women’s Hospital. “Waiting until women are in their 60s and 70s to start preventing heart attacks and strokes is a recipe for failure.”
An ounce of prevention
Each of these three risk factors can be influenced through a combination of lifestyle changes and drug therapy. Several randomized trials have shown that lowering cholesterol and reducing inflammation significantly reduces the risk of heart attacks and strokes.
Furthermore, several new drugs that significantly lower LPA as well as second-generation anti-inflammatory agents are being tested to see if they can also reduce disease rates.
“While we still need to focus on lifestyle basics like diet, exercise and smoking cessation, the future of prevention will undoubtedly be treatments that combine targeting inflammation and LpA in addition to cholesterol,” Ridker said, according to EurekAlert.