Studies on Cardiovascular Risk in Women: Brigham and Women's Hospital, an affiliate of Harvard Medical School, recently conducted research that identified three blood biomarkers that can predict cardiovascular risk decades before women experience heart attacks, strokes, or other major cardiovascular events. Their findings, presented at the European Society of Cardiology Congress in London and simultaneously published in the New England Journal of Medicine, may alter how physicians assess and manage heart disease in women by offering opportunities for earlier interventions.
This study followed 27,939 initially healthy American women for over 30 years. It used three biomarkers: low-density lipoprotein cholesterol (LDL-C, commonly referred to as "bad cholesterol"), high-sensitivity C-reactive protein (hsCRP), a marker of vascular inflammation; and lipoprotein (a), an Lp(a) determined genetic lipid fraction. When measured early in life, these markers provide a more accurate picture of cardiovascular risk than cholesterol measurements alone, allowing women more time to manage their health through lifestyle modifications or therapeutic interventions.
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Heart Disease Is A Wake-Up Call For Women
Cardiovascular disease remains the leading cause of female death in the U.S., with 44% living with some form of cardiovascular illness and accounting for one out of every five female deaths, according to data from American Heart Association and Centers for Disease Control and Prevention in 2021 alone - yet many women remain unaware of its dangers; only half identify heart disease as their number one killer.
Julie Buring, principal investigator and epidemiologist for Brigham's Women's Health Study as well as Brigham's Division of Preventive Medicine's Brigham and Women's Division, stressed the significance of early screening: "These data should serve as a wake-up call to women," according to Buring. Waiting until women reach their 60s or 70s before beginning heart attack and stroke prevention strategies is a sure way to guarantee failure.
At the time of enrollment in this study, participants averaged 54.7 years old on average, and many had risk factors such as hypertension, smoking, diabetes, or family histories of early heart attacks. Yet, all were considered healthy at the start. With time, however, the study determined that women with elevated levels of any one or all three biomarkers had significantly greater odds of experiencing major cardiovascular events.
Biomarkers Can Provide Decades-Long Early Warning Systems
Women who had higher levels of all three biomarkers were at greater risk for cardiovascular events; those with elevated hs-CRP levels faced a 70% greater risk, those with elevated LDL-C had a 36% greater risk, and those with elevated Lp(a) had 33% increased risks. Women exhibiting high levels of all three biomarkers were 2.6 times more likely to experience major cardiovascular events and 3.7 times more likely to have a stroke over 30 years than their counterparts who exhibited lower levels.
Though cholesterol is widely recognized as a risk factor for heart disease, among all three biomarkers, hsCRP was the strongest predictor. This marker indicates inflammation within blood vessels, which contributes to atherosclerosis or hardening of arteries. Yet, all three biomarkers must remain present as elevated levels can pose even greater dangers than individually.
Paul Ridker is the lead author and director of Brigham and Women's Hospital's Center for Cardiovascular Disease Prevention. To offer our patients the highest standard of care possible, it is imperative to implement universal screening for inflammation, cholesterol levels, and lipoprotein (a).
Addressing Risks
All these risk factors can be altered through lifestyle modifications and drug therapy. Randomized trials have demonstrated that lowering LDL-C through diet, exercise, and medications is highly effective at lowering heart attack and stroke risks; additionally, reducing inflammation with statins or anti-inflammatory agents has also been shown to lower cardiovascular risks.
Ridker suggests that new drugs specifically designed to lower Lp(a) levels are currently under testing and offer another possible intervention for women at risk. He predicts that future cardiovascular prevention strategies are likely to include combination therapies that target all three biomarkers: "While we still must prioritize lifestyle essentials such as diet, exercise, and smoking cessation for prevention purposes," such as combination therapies that target inflammation and Lp(a), in addition to cholesterol.
Call for Universal Screening Services (USSS)
The results of this study support a shift in how cardiovascular risk assessment for women takes place. Cholesterol levels have traditionally been the focal point for screenings to assess cardiovascular disease risk; however, the inclusion of other biomarkers like hs-CRP and Lp(a) could greatly enhance the accuracy of assessments and allow earlier intervention. Ridker and his team advocate for universal screening of all three biomarkers to identify women at risk long before any symptoms emerge.
The Women's Health Study, funded by the National Institutes of Health since 1993, has been following female health professionals aged 45 or older since 1993. As one of the longest-running studies of cardiovascular health in women, its latest findings could prove pivotal in altering how heart disease prevention strategies will evolve in future years.
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Given that heart disease remains the leading cause of death among women, these findings underscore the significance of taking proactive measures. Women must recognize that early screening, lifestyle modifications, and medical interventions could be key components in avoiding heart attacks or strokes long before they occur. Stay connected to the Education Post News for more updates.
