Three blood biomarkers may give women a picture of their heart disease risk decades in advance, study shows

Measuring the levels of three biomarkers in blood in midlife may give women a clearer picture of their risk of major cardiovascular events like heart attacks and strokes decades earlier than current risk calculators do, a new study suggests. When it comes to the worries that women have about their health, heart disease isn’t usually at the top of the list – but it probably should be. Heart disease is the No. 1 killer of women in the United States. In 2021, it was responsible for the deaths of more than 310,000 women, about 1 in every 5 female deaths, according to the US Centers for Disease Control and Prevention. About 80% of women ages 40 to 60 are living with at least one risk factor for coronary artery disease, research has found, but only about half of women recognize heart disease as their biggest health risk. Experts say that having better measures of risk earlier in life might help women take critical steps to improve their health before it’s too late. The tests highlighted in the study are not new. They are also inexpensive, ranging from $10 to $12 per test. The study found that these three test results, considered together, could predict cardiovascular risk in seemingly healthy women as much as 30 years before a major cardiovascular event like a heart attack or stroke, a finding that one of the authors said was astonishing. For the study, nearly 40,000 women were followed for 30 years starting in the early 1990s. The study participants were health professionals who were invited to enroll. At the start of the study, about 28,000 women agreed to provide blood samples. The researchers used these to measure three biomarkers: low-density lipoprotein, or LDL; high-sensitivity C-reactive protein, or CRP; and lipoprotein(a), or LP(a). These three factors each influence cardiovascular risk in different ways. LDL cholesterol contributes to fatty buildup in the arteries. High-sensitivity CRP is part of the immune system’s response to cholesterol, indicating inflammation in blood vessels. LP(a) is a lipid that can accumulate in blood vessels and form artery-clogging plaques. When the three biomarkers were considered together, women with high levels of all three were nearly three times more likely to have a major heart event and nearly four times more likely to have a stroke compared to those with low levels. The study suggests that doctors should be checking these markers as a routine part of primary care. Medications are available to lower LDL cholesterol and control inflammation. However, no drugs are specifically approved to lower LP(a), although several are being tested. The study is significant because most risk calculators tend to underestimate heart risks for women. However, it has limitations as the participants were predominantly White health professionals with better access to healthcare. The relevance of the findings to women of different socioeconomic backgrounds and ethnicities may differ. Overall, this study focuses on the importance of identifying and treating middle-aged women with elevated risks for heart disease earlier, rather than waiting until later in life.