Blood test screening for three biomarkers can warn women of risk decades before heart attack, stroke

Good news! What about men?

"Three biomarkers in blood can better predict the risk of major cardiovascular events in women decades earlier than previous tests, giving them more time to address their risk with lifestyle changes and therapeutics, according to research from Brigham and Women’s Hospital, a Harvard affiliate.

In a landmark study of 27,939 initially healthy American women, the researchers used a single measure of low-density lipoprotein cholesterol (LDL-C), or “bad cholesterol”; high-sensitivity C-reactive protein (hsCRP), a marker of vascular inflammation; and lipoprotein(a), a genetically determined lipid fraction, to predict risk over a 30-year follow-up period. ...

Researchers found that, compared to women with the lowest levels of individual markers:

• Women with the highest levels of hsCRP had a 70 percent greater risk of a major cardiovascular event;
• Women with the highest levels of LDL-C had a 36 percent greater risk;
• Women with the highest levels of Lp(a) had a 33 percent greater risk.

..."

From the abstract:

"Background

High-sensitivity C-reactive protein (CRP), low-density lipoprotein (LDL) cholesterol, and lipoprotein(a) levels contribute to 5-year and 10-year predictions of cardiovascular risk and represent distinct pathways for pharmacologic intervention. More information about the usefulness of these biomarkers for predicting cardiovascular risk over longer periods of time in women is needed because early-life intervention represents an important risk-reduction method.

Methods

We measured high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) levels at baseline in 27,939 initially healthy U.S. women who were subsequently followed for 30 years. The primary end point was a first major adverse cardiovascular event, which was a composite of myocardial infarction, coronary revascularization, stroke, or death from cardiovascular causes. We calculated the adjusted hazard ratios and 95% confidence intervals across quintiles of each biomarker, along with 30-year cumulative incidence curves adjusted for age and competing risks.

Results

The mean age of the participants at baseline was 54.7 years. During the 30-year follow-up, 3662 first major cardiovascular events occurred. Quintiles of increasing baseline levels of high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) all predicted 30-year risks.
Covariable-adjusted hazard ratios for the primary end point in a comparison of the top with the bottom quintile were 1.70 (95% confidence interval [CI], 1.52 to 1.90) for high-sensitivity CRP, 1.36 (95% CI, 1.23 to 1.52) for LDL cholesterol, and 1.33 (95% CI, 1.21 to 1.47) for lipoprotein(a).
Findings for coronary heart disease and stroke appeared to be consistent with those for the primary end point. Each biomarker showed independent contributions to overall risk. The greatest spread for risk was obtained in models that incorporated all three biomarkers.

Conclusions

A single combined measure of high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) levels among initially healthy U.S. women was predictive of incident cardiovascular events during a 30-year period. These data support efforts to extend strategies for the primary prevention of atherosclerotic events beyond traditional 10-year estimates of risk. ..."

Blood test can warn women of risk decades before heart attack, stroke — Harvard Gazette "Findings support universal screening of three biomarkers, not just cholesterol"

Inflammation, Cholesterol, Lipoprotein(a), and 30-Year Cardiovascular Outcomes in Women (no public access; you may create a free account to access this article)