Cardiovascular disease is the leading cause of death in women globally, but historically there have been disparities in diagnosing cardiovascular disease in women as they may have different symptoms than men. Researchers from Brigham and Women’s Hospital found that measuring three different biological blood markers can better predict a woman’s risk of having a major cardiovascular event over the next 30 years compared to measuring only one biomarker. The lead author of the study, Paul M Ridker, emphasized that heart disease in women remains under-diagnosed and under-treated, and interventions need to start much earlier. The study analyzed data from the Women’s Health Study, which has followed female health professionals ages 45 years and older since 1993, with the primary endpoint being a participant’s first major cardiovascular event.
The researchers argued that universal screening for hsCRP (a marker of inflammation in the arteries) and Lp(a) (another lipid marker) in addition to LDL or ‘bad’ cholesterol could help identify women at risk for heart disease. Ridker stressed that each of these biomarkers represents modifiable and different biologic processes responsible for developing heart disease, and the era of ‘one size fits all’ treatment should be over. When analyzing the data, they found that the percentage of risk of having a major cardiovascular event increased significantly in women with the highest levels of hsCRP, LDL-C, and Lp(a). Ridker was astonished to see that inflammation assessed by hsCRP was associated with risks 30 years down the road, indicating the profound impact of the immune system on atherosclerotic disease.
Participants with raised levels of all three biomarkers were found to be significantly more likely to have a major adverse cardiovascular event or a stroke over the next 30 years. Ridker emphasized the importance of catching these markers early in life to institute preventive therapies such as dietary changes, regular exercise, smoking cessation, and drug therapy, rather than waiting until later in life when risks are higher. He called for a shift in guidelines to include screening in younger age groups to address lifetime risks and allow for early interventions. Board-certified cardiologist Nicole Weinberg highlighted the importance of including lipoprotein(a) testing as it is considered a risk factor for coronary artery disease and valvular heart disease, emphasizing the need for advanced lipid tests to identify and modify cardiovascular risk factors.
In conclusion, the study findings suggest that measuring a combination of three different blood biomarkers can better predict a woman’s risk of having a major cardiovascular event over the next 30 years compared to measuring only one biomarker. This approach could help identify women at risk for heart disease early in life and allow for proactive preventive interventions. The researchers advocate for universal screening of hsCRP and Lp(a) in addition to LDL cholesterol to address specific biologic issues that put female patients at risk. This shift in guidelines could lead to more targeted and effective treatments for heart disease in women, highlighting the importance of early detection and intervention in reducing the burden of cardiovascular disease in this population.
