NEW YORK, Aug. 31 (UPI) -- A single blood test that measures inflammation and fat can predict women's risk for cardiovascular disease 30 years later, a new Harvard study suggests.
The findings, presented Saturday at the European Society of Cardiology Congress 2024 in London, were published in the New England Journal of Medicine.
Funded by the National Institutes of Health, the study could promote earlier detection and treatment for disorders of the heart and blood vessels.
Testing two types of fat in the bloodstream along with C-reactive protein, a marker of inflammation, may move the cardiology field closer to vital discoveries, researchers said.
"Heart disease remains underdiagnosed and undertreated in women, and unfortunately, our current screening guidelines detect high-risk women quite late in the game, well after prevention efforts should have been initiated," the study's lead author, Dr. Paul Ridker, told UPI via email.
"Cardiovascular disease is largely preventable, but we need to know what the underlying biologic problem is for the individual patient we are seeing in clinic, and we need to intervene very early," said Ridker, director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital and Harvard Medical School in Boston.
Patients should ask
"Yet, doctors don't treat what they don't measure, so patients themselves may need to ask to have these three biomarkers measured in their 40s and not wait until they are in their 70s. Our prevention guidelines need to change to endorse universal screening far earlier in life," he said.
Researchers collected blood samples and healthcare information from 27,939 U.S. medical providers enrolled in the Women's Health Study. For 30 years, they followed participants who entered the study between 1992 and 1995 at an average age of 55.
During this time, 3,662 women experienced a heart attack, stroke, surgery to restore circulation or a cardiovascular-related death.
Researchers evaluated how high-sensitivity CRP, along with low-density lipoprotein cholesterol and lipoprotein(a), or Lp(a), a lipid partly made of LDL, predicted the occurrence of these events alone or collectively.
They grouped participants into five categories, ranging from the highest to lowest levels, to measure each of the three markers.
Participants with the highest levels of LDL cholesterol incurred a 36% higher associated risk for heart disease compared to women with the lowest levels.
Individuals with the most significant levels of Lp(a) had a 33% elevated associated risk, and those with the greatest levels of CRP had a 70% heightened associated risk.
Far higher risk
When researchers assessed all three measures, participants with the highest levels had more than a 1.5 times increased associated risk for stroke and more than a three times raised associated risk for coronary heart disease compared to women with the lowest levels.
While the study only included women, researchers said they would anticipate comparable results in men.
"Based on a single blood sample, we could predict not just five- or 10-year risk of future heart attack, stroke and cardiovascular death, but we could predict risks a full 30 years in advance," Ridker said.
"Moreover," he added, "knowing all three biomarkers greatly improved our ability to predict risk. Crucially, all three of these are actionable, which is to say that this is not just about behavioral change -- it is about getting the right drug to the right female patient early enough to extend her life."
Researchers explained that immune cells, which enable the body to repair wounds or heal infection, also can sense the build-up of extra cholesterol or become activated in reaction to the accumulation of plaque and release inflammatory signals.
This results in a hyperinflammatory environment in which plaque can form, enlarge or rupture, leading to cardiovascular events.
Better outcomes
Measures to promote heart and vascular health add up and correlate with better long-term outcomes, researchers noted.
"Women are likely to underestimate their cardiovascular risk," Ridker said. "Diet exercise and smoking cessation need to be front and center much earlier in life."
Other important strategies include managing stress and avoiding tobacco or quitting smoking. In addition, women with elevations in any of the three biomarkers should ask their doctors about specific drug therapies to address the particular biologic issue that is revealed, Ridker said.
Some may benefit from a cholesterol-lowering medication, while others may require a targeted anti-inflammatory drug or perhaps both, he said, adding that "the era of one-size-fits-all is over -- we need to measure the different pathways that promote heart disease and tailor our interventions appropriately."
Intensive lifestyle modifications comprised of a healthy plant-based diet, daily exercise and weight control could reduce cardiovascular disease risks amid elevations in LDL, Lp(a) and CRP, said Dr. Deepak Bhatt, a cardiologist and director of Mount Sinai Fuster Heart Hospital in New York City. He was not involved in the study.
"In some people, cholesterol-lowering medications would be indicated," Bhatt said. "Clinical research is ongoing to see how best to target Lp(a), which is believed to be greatly influenced by genetics, and inflammation with novel medications."
A common lab test that measures LDL is part of the standard "cholesterol panel," which typically doesn't include CRP and Lp(a), said Dr. Blair Suter, an assistant professor of medicine in the division of cardiovascular diseases at The Ohio State University College of Medicine in Columbus.
"Long-term studies like this evaluating risk factors and laboratory assessments are crucial to our understanding of how we guide the preventive care for our patients across the lifespan," Suter said, noting that there are "many great therapies to target LDL."
He added that "predicting cardiac risk is difficult." Risk assessment includes family history, lifestyle and dietary factors, underlying medical conditions and laboratory testing. Additional support tools, such as the coronary artery calcium score, can help define risk.
"The study demonstrates that comprehensive screening for more advanced cardiovascular risk markers can lead to earlier and more effective interventions," said Dr. Rigved Tadwalkar, a consultative cardiologist at Pacific Heart Institute and Providence Saint John's Medical Foundation in Santa Monica, Calif.
"Awareness of these markers can prompt individuals to seek more thorough evaluations and discussions with their healthcare providers."
