When people worry about women's health, heart disease isn't usually at the top of the list. But research shows that heart disease has indeed become the "number one killer" of women and should attract greater attention. On August 31, local time, a major study announced at the European Society of Cardiology (ESC) conference in London found that measuring the levels of three biomarkers in the blood at middle age—high-sensitivity C-reactive protein (CRP), LDL cholesterol, and lipoprotein(a)—may allow women to predict their risk of heart disease 30 years in advance.
The researchers called the discovery "shocking." Because women develop coronary heart disease earlier in life, measuring these common indicators may change the prevention outcomes of heart disease risk.
Previous research has found that about 80% of women aged 40 to 60 have at least one risk factor for coronary artery disease, but only about half consider heart disease to be their greatest health risk. Better gauging informed risks earlier in life may help women take key steps to improve their health before it's too late, experts say.
The latest study, published in the New England Journal of Medicine during ESC, was based on 40,000 women with an average age of 55 years of follow-up for 30 years, with some of the youngest subjects being 40 years old.
The study found that each of the three biomarkers was associated with an increased risk of cardiovascular disease, with inflammation appearing to be the strongest driver. Women with the highest levels of high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) markers were 2.6 times more likely to have a major cardiovascular event and 3.7 times more likely to have a stroke in the next thirty years.
"Combined, the results of these three tests can predict cardiovascular risk in seemingly healthy women 30 years before a major cardiovascular event such as a heart attack or stroke. The role this plays in primary prevention was surprising to me," said study author Paul Ridke, director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital. "In fact, the processes that lead to atherosclerotic disease in these young women are present very early in life."
He said that based on current clinical recommendations, women generally do not need to consider preventive treatment for heart disease until they are in their 60s or even 70s. This latest study could mean changes to guidance.
Researchers analyzed that the three newly discovered indicators affect cardiovascular risk in different ways. Among them, LDL cholesterol can cause fat accumulation in arteries and has long been a classic indicator of heart disease risk; while high-sensitivity CRP is a newer indicator. It is part of the immune system's response to cholesterol and is also a way for researchers to measure latent inflammation in blood vessels, which cannot be felt by humans. When cholesterol starts to build up in the arteries, it can form crystals. The immune system sees the crystals as foreign material and begins a response to clear them, producing high-sensitivity CRP in the process.
Lipoprotein(a) is a lipid that can accumulate in blood vessels and form artery-clogging plaque, similar to LDL cholesterol. And a person's risk for high lipoprotein(a) levels is largely genetic. About one in five people worldwide have elevated levels of lipoprotein(a) but may not know it because they have no symptoms. Some people who lead a healthy lifestyle and have normal cholesterol levels may still develop blockages in their large arteries due to elevated lipoprotein(a).
This research also means that more drugs that can reduce these risk factors at an early stage are needed in the future. Currently, there are drugs that can lower LDL cholesterol and help control inflammation, including low-dose colchicine, a drug traditionally used to treat gout; but there are no drugs specifically approved for lowering lipoprotein(a).
China Business News reporter learned that pharmaceutical giants including Novartis, Amgen, and Eli Lilly are developing drugs to reduce lipoprotein(a) levels.
Professor Ge Junbo, academician of the Chinese Academy of Sciences and director of the Department of Cardiology at Zhongshan Hospital of Fudan University, is attending the ESC conference in London. He told China Business News that in recent years, people have paid more and more attention to lipoprotein(a), and clinical research on related drugs in China is also ongoing.
"Assessing women's risk of heart disease has always been difficult. Women tend to develop heart disease later in life than men. Existing risk prediction methods often underestimate women's risk of heart disease in the next few decades," said Sonia Tolani, co-director of the Columbia Women's Heart Center.
But some experts believe that this study also has some important limitations, such as that almost all of the women who participated in the study were white. Whether the findings of this study hold true among other women also deserves further exploration.