Testing for three biomarkers in a woman's bloodstream could shed light on her risk of developing heart attack, stroke, or other cardiovascular issues decades down the line

Study Finds These 3 Tests Could Help Predict Your Risk of a Heart Attack, Stroke

Testing for three biomarkers in a woman's bloodstream could shed light on her risk of developing heart attack, stroke, or other cardiovascular issues decades down the line

• A new study found that testing three biomarkers—CRP, LDL cholesterol, and Lp(a)—in a woman’s bloodstream may be able to predict her risk of experiencing heart attack, stroke, or other cardiovascular issues.
• About 60 million American women live with some form of heart disease, making it the leading cause of death for women in the U.S.
• Experts say these findings point to the importance of starting heart health screenings early and advise women to ask their healthcare providers about testing for these biomarkers.

Testing three biomarkers in a woman’s bloodstream may be able to predict her risk of experiencing heart attack, stroke, or other cardiovascular issues later in life, according to a new study.

A team of researchers looked at three biomarkers: low-density lipoprotein (LDL) cholesterol, lipoprotein(a)—also known as Lp(a)—and high-sensitivity C-reactive protein (CRP), an indicator of inflammation. They found that the three metrics were related to a woman’s risk of having an adverse cardiovascular event at least 30 years later.

The research was published in the New England Journal of Medicine on August 31 and included data from nearly 28,000 participants.

These findings point to the importance of starting heart health screenings early, especially since people can lower their inflammation and cholesterol levels if they’re too high, explained lead study author Paul Ridker, MD, MPH, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital.

“We need to start prevention much earlier and get these three biomarkers measured universally,” Ridker told Health. “Doctors do not treat what they do not measure.”

About 60 million American women live with some form of heart disease, making it the leading cause of death for women in the U.S.

Here’s what to know about how these three biomarkers can predict future cardiovascular health and which tests you should request at your next doctor’s visit.

Looking for Warning Signs of Future Heart Disease

Currently, measuring a person’s LDL cholesterol levels is the standard screening test for cardiovascular disease. However, Ridker and his colleagues thought adding other metrics might be useful.

High-sensitivity CRP “is a proven measure of silent inflammation, a very important process that leads to atherosclerotic disease,” he said. “We also measured [Lp(a)], which is a genetically determined blood fat that also can increase heart attack risk.”

The research team looked at participants’ blood tests measuring their CRP, LDL cholesterol, and Lp(a) levels going back three decades.

Researchers then tracked any recorded cardiovascular events, which included heart attacks, stroke, coronary revascularization, or death from cardiovascular causes.

They found that, compared to women who had the lowest levels of these biomarkers, women who had elevated levels were 2.6 times more likely to have a major cardiovascular event.

Additionally, women with the highest levels of high-sensitivity CRP had a 70% greater risk of a cardiovascular event. That risk was 36% and 33% higher for women with elevated levels of LDL cholesterol and Lp(a), respectively.

Though men were not included in this research, Ridker said these biomarkers would also likely predict an increased risk of cardiovascular issues for them.

How Are Inflammation and High Cholesterol Linked to Heart Health Issues?

Chronic inflammation has been linked to the development of cardiovascular issues—plus, risk factors for heart disease such as high blood pressure and smoking can, in turn, cause even more inflammation in the body.

“CRP levels can go up for a variety of reasons, and an extremely common reason in the U.S. population and increasingly around the world is obesity,” Anum Minhas, MD, cardiologist and assistant professor of medicine at the Johns Hopkins School of Medicine, told Health. “CRP could also be [elevated] for genetic reasons, or because the person has an autoimmune disease or other medical condition.”

Similarly, elevated levels of LDL cholesterol and Lp(a) have also been previously associated with an increased risk of cardiovascular issues, Tiffany Di Pietro, MD, a cardiologist in private practice in Fort Lauderdale, Florida, told Health.

“LDL or ‘bad cholesterol’ is one of the cholesterol particles which can be responsible for plaque buildup in the arteries in our bodies,” she said. This buildup of plaque makes the arteries more narrow, blocking blood from properly flowing to the heart.

Similar to inflammation, high LDL cholesterol levels are usually linked to poor diet, inactivity, smoking, or other lifestyle factors. But in some cases, it can be genetic, meaning “very healthy people can still have high LDL levels,” Di Pietro said.

Finally, high levels of Lp(a)—another cholesterol particle found in the blood—can also cause plaque and blood clots, she said.

Lp(a) levels are “purely genetic” and can’t be reduced by diet or exercise, Di Pietro added. It’s estimated that one in five people have elevated Lp(a) levels, though many people haven’t had their levels tested, Tracy Paeschke, MD, a preventive cardiologist in private practice based in Colorado, told Health.

Other Ways to Test Your Cardiovascular Risk

Along with the three biomarkers included in the study, Paeschke said she uses Apolipoprotein B (ApoB) tests to evaluate her patients’ cardiovascular risk—this is another way to directly measure particles in the blood that might promote plaque formation in the arteries.

In addition to bloodwork, healthcare providers might suggest a coronary CT angiogram, Di Pietro said. These scans use intravenous (IV) contrast dye to illuminate any blockages or issues in the arteries.

However, coronary CT angiograms and other types of imaging only tell doctors that a patient is at an increased risk of cardiovascular issues; it doesn’t necessarily tell them why or what to do about it, according to Ridker.

“By measuring [high-sensitivity] CRP and Lp(a) along with LDL cholesterol, we can determine what the specific biologic issue is,” he said. “For example, some patients will benefit from cholesterol-lowering with drugs like statins, whereas others will benefit from inflammation-lowering drugs like colchicine.”

There are currently medications in the works that will target Lp(a) and help lower levels, Minhas added.

Using imaging in combination with bloodwork tests allows doctors to provide an individualized heart health plan for patients so they can be more proactive about their health, Di Pietro said.

Requesting Heart Health Tests at Your Next Checkup

The results of this new study support universal screening for these three biomarkers, particularly among women. However, routine bloodwork may not include CRP or Lp(a) tests.

“In fact, even if you go to a cardiologist, it’s typically not something that is checked,” Minhas said.

The good news is that, while you’ll probably have to specially request them, both high-sensitivity CRP and Lp(a) tests are easily obtained in routine care “and are simple, inexpensive blood tests,” Ridker said.

Also, it’s important that people ask for a high-sensitivity CRP test rather than a “regular” CRP test, as the former can detect inflammatory proteins at lower levels, Ridker and Di Pietro noted.

Knowing your risk of cardiovascular disease is especially important if you have a family history—your primary care physician may want to keep a closer eye on your Lp(a) levels or refer you to a cardiologist if appropriate, said Minhas.

“Just because you have a family history of something doesn’t mean you are doomed, [or] that you will 100% develop the condition,” she explained. “There are things that might be out of your control, like your genetics, but there’s things that are in your control that you can focus on, like leading a healthier lifestyle.”

In fact, for Minhas, focusing on modifiable risk factors for heart disease is the most important takeaway from the new research. Indeed, Ridker stressed that early diet and exercise modifications and smoking cessation should be a priority.

“Our 30-year data show that [cardiovascular] risk increases quite early in life, so we need to start prevention efforts in our 30s and 40s, and not wait until we are 60 or 70,” he said.

This story originally appeared on: Health News - Author:Elizabeth Yuko, PhD