​# New Research: Three Tests to Help Predict Women's Heart Attack and Stroke Risks

A new study has found that detecting three biomarkers in women's blood - CRP, LDL cholesterol, and Lp(a) - might be able to predict their risk of heart disease, stroke, or other cardiovascular diseases. Approximately 60 million women in the United States have some form of heart disease, and heart disease is the leading cause of death among American women. Experts say these findings highlight the importance of starting heart health check - ups as early as possible and recommend that women consult their healthcare providers about testing for these biomarkers. A group of researchers studied 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 these three indicators are associated with the risk of adverse cardiovascular events in women at least 30 years later. The study was published in The New England Journal of Medicine on August 31 and included data from nearly 28,000 participants. Paul Ridker, MD, MPH, director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital and the lead study author, explained that these findings emphasize the importance of starting heart health check - ups early, especially since people can lower inflammation and cholesterol levels if they are too high. "We need to start prevention early and measure these three biomarkers universally," Ridker told Health magazine. "Doctors don't treat diseases they don't measure." ## Looking for Warning Signs of Future Heart Disease Currently, measuring a person's LDL cholesterol level is the standard screening test for cardiovascular disease. However, Ridker and his colleagues believe that adding other indicators could be useful. "High - sensitivity CRP has been proven to be an indicator of silent inflammation, and silent inflammation is a very important process in the development of atherosclerotic diseases. We also measured [Lp(a)], a genetically determined blood lipid that also increases the risk of a heart attack," he said. The research team looked at the participants' blood test results over 30 years and measured their CRP, LDL cholesterol, and Lp(a) levels. The researchers then tracked any recorded cardiovascular events, including heart attacks, strokes, coronary revascularization, or death from cardiovascular causes. They found that women with elevated levels of these biomarkers were 2.6 times more likely to have a major cardiovascular event compared to women with the lowest levels of these biomarkers. In addition, women with the highest levels of high - sensitivity CRP had a 70% higher risk of a cardiovascular event. Women with elevated levels of LDL cholesterol and Lp(a) had a 36% and 33% higher risk of a cardiovascular event, respectively. Ridker said that although the study did not include men, these biomarkers might also predict an increased risk of cardiovascular disease in them. ## The Association between Inflammation, High Cholesterol, and Heart Health Problems Chronic inflammation is associated with the development of cardiovascular problems. In addition, risk factors for heart disease such as high blood pressure and smoking can, in turn, cause the body to produce more inflammation. Anum Minhas, MD, a cardiologist and assistant professor of medicine at Johns Hopkins School of Medicine, told Health magazine, "There are many reasons for elevated CRP levels. One extremely common reason in the U.S. population is obesity, which is also becoming more prevalent worldwide. Elevated CRP levels can also be due to genetic reasons or because the patient has an autoimmune disease or other conditions." Tiffany Di Pietro, MD, a cardiologist at a private practice in Fort Lauderdale, Florida, told Health magazine that elevated levels of LDL cholesterol and Lp(a) are also associated with an increased risk of cardiovascular disease. "LDL, or 'bad cholesterol', is one of the cholesterol particles that can cause plaque to form in the arteries in our bodies," she said. The accumulation of plaque narrows the arteries and blocks the normal flow of blood to the heart. Similar to inflammation, high levels of LDL cholesterol are usually associated with a poor diet, lack of exercise, smoking, or other lifestyle factors. However, in some cases, it can be genetic, meaning that "very healthy people can still have high LDL levels," Di Pietro said. She also said that high levels of Lp(a) (another cholesterol particle in the blood) can also cause plaque and blood clots. Lp(a) levels are "purely genetically determined" and cannot be reduced by diet or exercise. It is estimated that one in five people has elevated Lp(a) levels, although many people have not been tested for these levels, Dr. Tracy Paeschke, a preventive cardiologist at a private practice in Colorado, told Health magazine. ## Other Methods for Testing Cardiovascular Risk Dr. Tracy Paeschke said that in addition to the three biomarkers mentioned in the study, she also uses the apolipoprotein B (ApoB) test to assess a patient's cardiovascular risk - another method of directly measuring the particles in the blood that may promote the formation of arterial plaques. Dr. Di Pietro said that in addition to blood tests, healthcare providers may also recommend coronary CT angiography. These scans use intravenous contrast agents to visualize any blockages or problems in the arteries. However, Ridker pointed out that coronary CT angiography and other types of imaging can only tell doctors that a patient's risk of cardiovascular disease has increased, but not necessarily the cause or how to deal with it. "By measuring [high - sensitivity] CRP and Lp(a) as well as LDL cholesterol, we can identify specific biological problems," he said. "For example, some patients will benefit from taking cholesterol - lowering drugs such as statins, while others will benefit from taking anti - inflammatory drugs such as colchicine." Minhas added that drugs targeting Lp(a) and helping to reduce its levels are currently under development. Di Pietro believes that by combining imaging and blood tests, doctors can create personalized heart health plans for patients so that they can be more proactive in taking care of their health. ## Requesting Heart Health Checks during the Next Physical Examination The results of this new study support universal screening for these three biomarkers, especially for women. However, routine blood tests may not include CRP or Lp(a) tests. "In fact, even if you go to a cardiologist, this usually isn't checked," Minhas said. The good news is that although you may need to specifically request them, high - sensitivity CRP and Lp(a) tests are easily available in routine care "and are simple, inexpensive blood tests," Ridker said. In addition, Ridker and Di Pietro emphasized that it is important for people to have high - sensitivity CRP tests rather than "routine" CRP tests because the former can detect lower levels of the inflammatory protein. Minhas said that if you have a family history of the disease, it is especially important to understand your risk of cardiovascular disease - your primary care doctor may closely monitor your Lp(a) level or refer you to a cardiologist if appropriate. "Just because you have a family history doesn't mean you're doomed to get the disease, [or] that you will definitely get it," she explained. "There are things that may be out of your control, like your genes, but there are also things you can control, and you can focus on those, like living a healthier lifestyle." For Minhas, focusing on modifiable risk factors for heart disease is the most important conclusion of this new study. Ridker emphasized that early diet changes, increased exercise, and smoking cessation should be top priorities. "Our 30 - year data shows that cardiovascular risk starts to increase early in life, so we need to start prevention in our 30s and 40s, not wait until our 60s or 70s," he said.