Study Reveals Blood Tests Predict Heart Disease in Women

Although cardiovascular disease is the number one cause of death in the United States, these conditions are mostly preventable when you know your risk and take action with a healthy diet, regular exercise, and cholesterol and blood pressure management.

Unfortunately, many women don’t get the chance to protect their heart health, because cardiovascular disease in women is underdiagnosed and undertreated. 

Now, new Mass General Brigham research shows that three simple items on a blood test can predict a woman’s risk of heart attack, stroke, and cardiovascular death:

• High-sensitivity C-reactive protein (hsCRP)
• Low-density lipoprotein cholesterol (LDL-C)
• Lipoprotein(a) or LP(a)

Paul Ridker, MD, MPH, a Mass General Brigham cardiologist who co-led the study, says two of the three are not currently included in national guidelines, so most people don’t receive those unless they ask.

“All three are simple blood tests that are inexpensive and easily obtained,” says Dr. Ridker, who cares for patients at Brigham and Women’s Hospital. “Everybody should have all three of these things measured early in life.”

Current guidelines to calculate cardiovascular risk

To determine a person’s risk of stroke, heart attack, and other cardiovascular disease, doctors assess certain factors, based on current guidelines from the American Heart Association and other organizations:

• Blood glucose (sugar)
• Blood pressure
• Body weight, which is calculated into body mass index (BMI) based on height and weight
• Family history of cardiovascular disease
• Lifestyle factors such as diet, exercise, and history of smoking
• Total cholesterol, including LDL cholesterol, high-density lipoprotein (HDL) cholesterol (also called “good cholesterol”), and triglycerides

Based on that information, doctors calculate a risk score that Dr. Ridker argues is outdated.

“Our prediction models and risk scores ask us to measure several items that we can’t do anything about, such as family history. And we have learned over the past 40 years that changing other factors, such as HDL cholesterol and triglycerides, doesn’t actually change risk,” he says.

Furthermore, he says, the current method generally doesn’t indicate that a woman is at high risk until she’s 65 or 70 years old. The reason is that most women don’t develop clinical signs and symptoms, such as high cholesterol or high blood pressure, until later in life. A better prediction model could help people recognize risk and take action much earlier.

Study of women’s heart health shows importance of blood test for cardiovascular disease

Dr. Ridker’s research used data from the Women’s Health Study to follow the heart health of 27,939 women over 30 years. Every woman in the study had a blood test that included many different measurements. 

The study followed the women for decades and recorded their first major cardiovascular event. Then researchers analyzed which measurements were most associated with cardiovascular events. They identified three important markers:

hsCRP

The strongest predictor of future cardiovascular events was hsCRP, which measures a protein that indicates inflammation in the body. Women with the highest levels of hsCRP had a 70% higher risk of a major cardiovascular event.

Dr. Ridker stresses that there are strategies to control hsCRP. People who exercise regularly have lower levels of the inflammation marker. So do people who eat healthy diets with lots of plant-based foods. In addition, certain targeted anti-inflammatory therapies lower hsCRP, which can lower the risk of a heart attack, stroke, and death from a cardiovascular event. 

The U.S. Food and Drug Administration (FDA) recently approved the first targeted anti-inflammatory drug to prevent heart disease: low-dose colchicine. The inexpensive medication has been shown to lower the risk of a heart attack or stroke by 25% to 30%.

LDL-C

LDL-C, often referred to as “bad” cholesterol, is routinely measured in blood tests. It has long been known to be a risk factor for cardiovascular disease. In Dr. Ridker’s study, women with the highest levels of LDL-C had a 36% greater risk of having a cardiovascular event.

As with hsCRP, LDL-C is controllable to some degree. “We have overwhelming evidence that if we reduce LDL-C with diet, exercise, and statins or lipid-lowering drugs, we can lower risk of cardiovascular events,” Dr. Ridker says.

LP(a)

This is a type of fat that is present in about 10% to 20% of people. Women in the study with the highest levels of LP(a) had a 33% greater risk of a cardiovascular event.

LP(a) is passed down through families, so you either have it or you don’t. If a close family member has LP(a), you should be tested — and you only need to have it tested once in your life. Several new drugs can lower LP(a), and studies are currently assessing whether they lower the rates of heart attack and stroke.

“Most people have levels that are quite normal, but if you happen to have a very high level, you’re well known to be at high risk,” Dr. Ridker says. “If you’re one of the people who have it, you probably want to know about it, because you would start preventive interventions in your 30s or 40s, not in your 60s or 70s.”

Get tested to understand your risk of heart disease.

The study showed that a woman can be at high risk of heart disease because of any one of these factors or a combination. Dr. Ridker hopes the remarkable results will lead to changes in national guidelines to screen at younger ages and help identify people who need earlier intervention.

“Why wait until you’re 55, 65, or 70 years old to find out that we should have been concerned about your inflammation, your cholesterol, or your LP(a) decades earlier,” he says. “At a minimum, we could institute more aggressive diet, exercise, smoking cessation, and even medication when people are much younger.”

Dr. Ridker encourages women to bring the research findings to their primary care providers and ask for the tests to better understand their risk.