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Measuring levels of three biomarkers in the blood in midlife could shed more light on women's risk of developing major cardiovascular problems, such as heart attack and high blood pressure, decades earlier than current risk calculators suggest, a new study suggests.
When it comes to women's health concerns, heart disease isn't usually at the top of the list — but it can be.
Heart disease is the number 1 killer of women in the United States. In the year It is responsible for more than 310,000 women's deaths by 2021, accounting for 1 in 5 female deaths. As he says US Centers for Disease Control and Prevention. In Care Of 80% women A study found that people between the ages of 40 and 60 are at least one risk factor for coronary artery disease. Women's half Recognize heart disease as their biggest health risk.
Having better risk metrics earlier in life can help women take critical steps to improve their health before it's too late, experts say.
The challenges described in the study are not new. “These are widely available. The study's author, Dr. Paul Ridker, director of the Cardiovascular Disease Prevention Center at Brigham and Women's Hospital, said the box is nothing more than a test of lab paper. He said they are cheaper at $10 to $12 per test.
The study showed that these three tests together could predict cardiovascular risk in otherwise healthy women up to 30 years before a major cardiovascular event such as a heart attack or stroke, a finding that surprised Ridker.
“Working on primary prevention worries me because it's telling us that the process that causes atherosclerosis in these young women is still in their lives,” he said.
For the study, published Saturday in the New England Journal of Medicine and presented at the European Society of Cardiology meeting in London, Ridker and his colleagues followed nearly 40,000 women for 30 years, beginning in the early 1990s. The study was funded by the US National Institutes of Health.
The study participants were health professionals who were invited to enroll. At the start of the study, their average age was 55, but some were almost 40 years old. About 3% had a history of diabetes and 14% had at least one parent who had a heart attack before age 65.
At the start of the study, some 28,000 women agreed to give a blood sample. The researchers used these to measure three biomarkers: low-density lipoprotein, or LDL, commonly known as bad cholesterol; High-sensitivity C-reactive protein, or CRP; and lipoprotein(a), or LP(a).
Each of these three factors affects cardiovascular risk in different ways.
LDL cholesterol contributes to the buildup of cholesterol in the arteries and has long been a common measure of heart risk.
High sensitivity CRP is new. It's part of the immune system's response to cholesterol, and it's a way for researchers to measure inflammation that drips into the blood vessels, the kind that a person can't feel.
When cholesterol begins to build up in the arteries, it forms crystals. The immune system sees the crystals as foreign and begins to respond to clear them. In the process, high-sensitivity CRP is produced.
LP (a) – Pronounced LP-little-a – It is greasy. It can accumulate in blood vessels and form artery-clogging plaques similar to LDL cholesterol. A person's risk for high LP(a) levels is largely genetic. Around 1 in 5 people worldwide have high levels of LP(a) but may not know it because they have no symptoms. A person can live a healthy lifestyle, have normal cholesterol, and still develop coronary artery disease due to LP(a).
In the clinic, doctors examine and measure each of these biomarkers individually. But they are not independent of each other in terms of the biological eruptions they ignite, Ridker said.
Dr. Leslie Cho, director of the Women's Cardiovascular Center at the Cleveland Clinic, said that is a major strength of this study.
“It's the additive effect of the risk factors that are so interesting and so incredibly powerful,” said Cho, who was not involved in the study.
At the end of the study, researchers looked to see how many participants experienced a major cardiovascular event: heart attack, stroke, opening of an artery near the heart, or death from a cardiovascular event. Women in the study experienced approximately 3,600 first major cardiovascular events.
The researchers divided the participants into five roughly equal parts called quintiles based on their level of each biomarker and compared those in the highest quintile with those in the lowest risk of major cardiovascular events.
Each of the three biomarkers was found to be associated with an individual's risk of cardiovascular disease, with inflammation appearing to be the strongest driver.
Women with high levels of high-sensitivity CRP — more than 5.18 milligrams per liter — were about 70% more likely to develop serious heart problems than those with low levels. Women with high LDL levels — more than 151 milligrams per deciliter — had a 36% higher risk of a major heart event. And women with high LP(a) levels—over 44 milligrams per deciliter—had a 33% greater risk of a major cardiovascular event.
When the three biomarkers were considered together, the results were stronger. Compared to women who did not have high levels of these three biomarkers, those with high levels of all three were nearly three times more likely to have a serious heart attack and nearly four times more likely to have a stroke.
“We continue to underdiagnose women compared to men,” Ridker said, adding that one of the main messages of the study is that middle-aged women at higher risk should be identified and treated earlier.
“Why do we start statins in women at 65 when we start in men at 50? Right? I mean, it's biologically stupid,” Ridker said.
The study suggests that doctors should screen for these symptoms as part of routine primary care, but many do not, said Dr. Gina Lundberg, clinical director of the Women's Heart Center at Emory University.
“Many doctors never draw c-reactive protein or LP(a) levels, so they are missing this information,” said Lundberg, who was not involved in the study.
Ridker said he hopes the study will educate doctors about the importance of ordering these tests. “I personally would like to see universal screening for these three things,” he said.
There are medications to lower LDL cholesterol and control inflammation, including low doses of colchicine, a drug commonly used to treat gout. However, no specific drug has been approved to lower LP(a), although several are being tested.
The new study is important because most risk calculators underestimate heart risks in women, independent experts said.
“It's always been very difficult to assess the risk of heart disease in women because women tend to get heart disease later in life. A lot of the traditional risk factors that we use—the main one is the American Heart Association calculator—tend to underestimate the lifetime risk in women,” says Columbia Women's Heart Center chief. Director Dr Sonia Tolani said.
The study also has some important limitations. Almost all of the women who participated in the study were white. Because they were health professionals themselves, they had better than average access to health care and health information and were healthier in many ways than women.
“Is it applicable to women across the socioeconomic spectrum? And is it going to be extended to minority women?” Tolani asked of the findings.
African American and South Asian women tend to have higher levels of LPL(a) than whites, Tolani noted, so part of the study may not apply to them.
“I think that's the biggest flaw I see,” she said.
On the other hand, risk factors for heart disease in women have been neglected for a long time, so this study is a major milestone in this regard.
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“We don't have a lot of studies in women, in cardiology or in general medicine, so it's good to have a study that focuses on women and looking at their vulnerability,” said Dr. Anum Minas, MD, Cardio-Obstetrics at Johns Hopkins School of Medicine.
“Looking at it 30 years ago, you have a very strong chance of preventing even the risk factors for heart disease,” said Minhas, who was not involved in the study.
Although all three biomarkers are well known to cardiologists, the high-sensitivity CRP and LP(a) tests are not measured or used in primary care, where doctors may first screen patients.
For those looking to get the results of these tests at their next checkup, Ridker suggests it might be wise to come prepared.
“You might want to bring the paper with you,” he said.