Concerns about women’s health often do not immediately bring to mind heart disease, but research has consistently shown that it is the leading cause of death among women, warranting greater attention. A groundbreaking study presented at the European Society of Cardiology (ESC) Congress in London on August 31 has revealed that a simple blood test measuring three biomarkers can predict the risk of heart disease in women up to 30 years in advance.
The study, published in the New England Journal of Medicine during the ESC, focused on high-sensitivity C-reactive protein (CRP), LDL cholesterol, and lipoprotein(a) levels in middle-aged women. The findings are described as stunning by researchers, as they indicate that the process leading to coronary heart disease in women begins much earlier in life than previously thought.
The Shocking Discovery
The researchers followed 40,000 women with an average age of 55 for 30 years, with some participants as young as 40. The study found that these three biomarkers are associated with an increased risk of cardiovascular disease, with inflammation being the strongest driver. Women with the highest levels of all three markers were 2.6 times more likely to experience a major cardiovascular event and had a 3.7-fold increased risk of stroke over the next three decades.
Paul Ridker, the study’s author and the director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in the United States, expressed his astonishment at the predictive power of these tests. The combination of these three tests can predict the risk of major cardiovascular events in seemingly healthy women up to 30 years in advance, which is quite a revelation in primary prevention, he said. In fact, the process that leads to atherosclerotic disease in these young women begins early in life.
Implications for Clinical Guidelines
According to current clinical guidelines, women typically do not need to consider preventive treatments for heart disease until they are in their 60s or even 70s. This latest research may suggest a need for a change in these guidelines.
The three biomarkers affect cardiovascular risk in different ways. LDL cholesterol leads to fatty buildup in arteries and has long been a classic indicator of heart disease risk. High-sensitivity CRP is a newer marker that is part of the immune system’s response to cholesterol and is a way for researchers to measure latent inflammation in blood vessels, which is not detectable by individuals. When cholesterol begins to accumulate in arteries, it forms crystals that the immune system views as foreign, triggering a response that produces high-sensitivity CRP.
Lipoprotein(a), similar to LDL cholesterol, accumulates in blood vessels and can form arterial-blocking plaques. The risk of high lipoprotein(a) levels is largely genetic, with about one-fifth of the global population having elevated levels without any symptoms, as they lead healthy lifestyles with normal cholesterol levels.
Future Developments
The study also suggests a need for more medications that can reduce these risk factors early on. Currently, there are drugs that can lower LDL cholesterol and help control inflammation, including low-dose colchicine, traditionally used to treat gout. However, there are no drugs specifically approved for lowering lipoprotein(a) levels.
First Financial Daily has learned that pharmaceutical giants, including Novartis, Amgen, and Eli Lilly, are developing drugs to lower lipoprotein(a) levels.
Professor Ge Junbo, an academician of the Chinese Academy of Sciences and the director of the Department of Cardiology at Zhongshan Hospital Affiliated with Fudan University, who is attending the ESC Congress in London, told First Financial Daily that there has been a growing focus on lipoprotein(a) in recent years, and clinical research on related drugs is also underway in China.
Challenges and Limitations
Despite the promising findings, the study has some significant limitations, including the fact that almost all participants were white. Whether the results of this study apply to other ethnic groups remains to be explored.
Sonia Tolani, the co-director of the Women’s Heart Center at Columbia University, noted that assessing heart disease risk in women has always been challenging, as they often develop heart disease later in life compared to men. However, some experts believe that the current risk prediction methods often underestimate the risk of heart disease in women over the next few decades.
In conclusion, this study offers a promising new approach to predicting heart disease risk in women decades in advance, potentially leading to earlier interventions and improved health outcomes.
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