Discover how three key biomarkers can predict a woman's risk of heart disease up to 30 years in advance, enabling earlier intervention and personalized prevention strategies.
A study published in the New England Journal of Medicine suggests that a combined measure of three biomarkers can predict a woman's risk of heart disease up to 30 years in advance.
The study followed approximately 28k initially healthy women in the United States for a period of 30 years (1992-2023), with a primary endpoint of a first major adverse cardiovascular event (n=3.6k). Baseline blood testing included measurement of high-sensitivity CRP (hsCRP), low-density lipoprotein (LDL), and lipoprotein (a) (Lp(a)). Researchers examined how each of these biomarkers independently predicted cardiovascular events, as well as when assessed together.
Data found that each biomarker independently contributed to cardiovascular disease risk. Women with the highest levels of hsCRP had a 70% increased risk of heart disease compared to those with the lowest levels. Those with the highest LDL levels had a 36% increased risk, and women with the highest Lp(a) levels were found to have a 33% increased risk. However, combining all three biomarkers provided the greatest predictive power. Those participants with the highest levels of all three biomarkers had more than 1.5 times increased risk for stroke, and more than 3 times increased risk for coronary heart disease when compared to women with the lowest levels of all three biomarkers.
Previous studies have found that nearly 75% of patients hospitalized for an MI have cholesterol levels that would indicate they are not at high risk for a cardiovascular event. To more accurately assess risk, guidelines for the prevention of heart disease have broadened to include biomarkers such as Lp(a) and hsCRP. The National Lipid Association now recommends one measurement of Lp(a) levels at least once a lifetime in every adult (NLA Scientific Statement on Use of Lp(a) in Clinical Practice, 2019). Further information on this marker and its use as a CV risk predictor (limited to substantially elevated levels) can be found in our CRL Lp(a) white paper.
hsCRP is included in guidelines from the American Heart Association and CDC for the primary prevention of cardiovascular disease (ACC/AHA Guideline for Primary Prevention of CVD, 2019). However, hsCRP is variable over time and correlates with multiple other CV risk factors sometimes reducing its value as an independent risk predictor in other studies. An alternative approach to measuring inflammation is to perform a multivariate analysis of all risk factors correlated with hsCRP (and presumably the cause of inflammation) which are typically measured on exam and laboratory studies. An example of this approach is the CRL Smart Score, a composite measure of all-cause mortality risk (rather than CV events) based on the life insurance exam and laboratory studies.
In line with current guidelines, this NEJM study illustrates the utility of hsCRP, LDL, and Lp(a) in predicting the long-term risk of heart disease in women. Expanding standard testing profiles to include these biomarkers could allow for earlier intervention and personalized prevention strategies, significantly improving women's heart health outcomes. CRL will continue to research the biomarkers mentioned above, as well as others, which could provide additional insight into an applicant’s risk for cardiovascular disease beyond currently utilized individual tests.
About the Author
Dr. Fehling has been with CRL since 2008 and is a certified High Complexity Laboratory Director by the American Board of Bioanalysis (ABB). Dr. Fehling serves as the Laboratory Director for CRL’s Molecular Diagnostics/Esoteric Laboratory. More broadly, Dr. Fehling provides scientific leadership across all business units at CRL with her extensive experience in laboratory management, new assay development, and business development.