Single Blood Test Could Predict Cardiovascular, Stroke Risk in Women for Up to 30 Years

Paul Ridker, MD
Credit: Brigham and Women's Hospital

A single blood test could predict cardiovascular for women for up to 3 decades, according to new research presented at the European Society of Cardiology (ESC) Congress 2024.

The study, which leveraged high-sensitivity CRP (hsCRP), LDL cholesterol, and lipoprotein(a)[Lp(a)] levels to predict cardiovascular risk in more than 27,000 healthy women, found each biomarker was associated with independent contributions to cardiovascular risk, with the models using all 3 biomarkers proving the most valuable for risk stratification.

“Doctors cannot treat what they don’t measure,” said lead author Paul Ridker, MD, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital, who presented the findings at ESC Congress 2024. “To provide the best care for our patients, we need universal screening for inflammation, cholesterol, and lipoprotein(a), and we need it now. By so doing, we can target our treatments to the specific biologic need of individual patients, fulfilling our longstanding hope to provide truly personalized preventive care.”

As a result of decades of research, what has become a modifiable risk factor in cardiology has undergone a revolution since the turn of the century. Although the risk associated with LDL-C has been well-elucidated since the 1950s, both hsCRP and Lp(a) have garnered significant attention as newer research has evidenced the magnitude of risk driven by each of these factors.

To explore the associations with risk among people without a history of cardiovascular disease, Ridker and colleagues designed their research endeavor as an analysis of data from the Women’s Health Study. A National Institutes of Health-funded study launched in 1993, the Women’s Health Study enrolled female health professionals aged 45 and older, with continued follow-up lasting until death.

Per study protocol, women who participated in the Women’s Health were asked to provide a blood sample upon enrollment, with this test recording information related to hsCRP, LDL-C, and Lp(a). For the current analysis, investigators sought to assesses the predictive value of each factor individual and in combination for predicting risk of first major adverse cardiovascular events, which investigators defined as a composite of myocardial infarction, coronary revascularization, stroke, or death from cardiovascular causes.

Of the 39,876 women enrolled in the Women’s Health Study from 1992 to 1995,28,345 study participants elected to provide a baseline blood sample and 27,939 had samples assayed. This cohort had a mean age of 54.7 years, mean BMI of 25.9 kg/m2, and 94.0% were White. Investigators pointed out 25.0% had hypertension, 12.0% were current smokers, 2.5% had diabetes, 14.4% had a parental history of myocardial infarction before 65 years of age.

During the follow-up period, which lasted a median of 27.4 (Interquartile range, 22.6) years, 3662 first major cardiovascular events occurred among the cohort.

Results of the covariable-adjusted analysis revealed the following level of risk associated with quintile 5 relative to quintile 1:

• hsCRP: Hazard Ratio [HR], 1.70; 95% confidence interval [CI], 1.52 to 1.90
• LDL-C: HR, 1.36; 95% CI, 1.23 to 1.52
• Lp(a): HR, 1.33; 95% CI, 1.21 to 1.47

Additional analysis revealed having levels in the highest quintile for all 3 biomarkers was associated with a more than doubling in risk of the primary endpoint (HR, 2.63; 95% CI, 2.16 to 3.19). Further analysis of this same group revealed a 68% increase and more than tripling in risk for coronary heart disease (HR, 1.68; 95% CI, 1.14 to 2.48) and stroke (HR, 3.71; 95% CI, 2.94 to 4.68), respectively.

“These data should be a wake-up call for women,” said study investigator Julie Buring, ScD, principal investigator of the Women’s Health Study and an epidemiologist in the Brigham’s Division of Preventive Medicine. “Waiting until women are in their 60s and 70s to initiate heart attack and stroke prevention is a prescription for failure.”