NEW YORK, Sept 3: A new method for routine blood tests could forecast a person's risk of heart disease over the next 30 years, according to research published on Saturday in the New England Journal of Medicine. Traditionally, doctors have evaluated cardiovascular risk by measuring cholesterol levels, particularly focusing on LDL, or “bad” cholesterol. However, relying solely on cholesterol measurements may overlook significant, often silent, risk factors.

Lead study author Dr. Paul Ridker, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in Boston emphasized that other biomarkers also play a critical role in predicting cardiovascular risk. The study, presented at the European Society of Cardiology Congress 2024 in London, highlights the importance of additional markers such as lipoprotein (a) or Lp(a), and C-reactive protein (CRP), an inflammation indicator.

The researchers analyzed data from nearly 30,000 US women who participated in the Women’s Health Study, enrolling between 1992 and 1995 when they were approximately 55. Over the 30-year follow-up period, around 13% of these women experienced significant cardiovascular events, including heart attacks, strokes, or deaths related to heart disease.

Dr. Ridker noted that while the study focused on women, the findings are likely applicable to men as well. “This is a largely preventable disease, but women tend to be undertreated and underdiagnosed,” he said.

At the start of the study, blood tests measured participants’ LDL cholesterol, Lp(a), and CRP levels. The study found that these measurements, both individually and collectively, were effective in predicting long-term heart health. Women with the highest levels of LDL cholesterol had a 36% increased risk of heart disease compared to those with the lowest levels. Similarly, high levels of Lp(a) were associated with a 33% higher risk, and elevated CRP levels indicated a 70% increased risk. When all three markers were combined, women with the highest levels were 1.5 times more likely to have a stroke and over three times more likely to develop coronary heart disease over the following 30 years compared to women with the lowest levels.

The study suggests that while traditional risk factors like obesity, diabetes, high blood pressure, and high cholesterol are well-known, testing for Lp(a) and CRP can reveal less obvious risks. Dr. Rachel Bond, system director of women’s heart health at Dignity Health in Arizona, who was not involved in the study, recommended that everyone get tested for Lp(a) once in their lifetime. Elevated levels of Lp(a) persist throughout life, although post-menopausal women may need re-evaluation.

Dr. Ridker advocates for conducting this comprehensive blood test in people’s 30s or 40s to identify hidden risks early, allowing for timely intervention. Although lifestyle changes such as exercise and a healthy diet are crucial, Dr. Steven Nissen, chief academic officer of the Heart, Vascular, and Thoracic Institute at the Cleveland Clinic, noted that medication may be necessary for those with elevated Lp(a), LDL, and CRP levels, as lifestyle modifications alone may not suffice.

The study has limitations, including a lack of racial and ethnic diversity, with 94% of participants being white. Nissen also pointed out that the study did not measure Lp(a) levels beyond a certain threshold, potentially underestimating its risk. Dr. Kunihiro Matsushita, a professor of epidemiology at Johns Hopkins Bloomberg School of Public Health, cautioned that while inflammation is a key factor, CRP may not be the most accurate marker for cardiovascular disease risk. He suggested that further research could refine the choice of biomarkers.

Dr. Ridker emphasized that comprehensive testing is crucial, as “physicians will not treat things they don’t measure.”