October 2024
Study finds three blood biomarkers predict long-term risk of CV events in women
By Rebecca Jenkins
A single combined measure of three blood biomarkers can predict incident cardiovascular (CV) events in initially healthy women over an almost 30-year period, a large study finds.
The research, which was presented at the European Society of Cardiology (ESC) Congress 2024 in London, evaluated the predictive value of a single baseline measurement of high-sensitivity C-reactive protein (CRP), LDL cholesterol and lipoprotein(a) levels in a prospective cohort of 27,939 initially healthy female US health professionals enrolled in the Women’s Health Study.
The mean age of the participants was 54.7 years, 94% were white and there were 3662 first major CV events over a median follow up of 27.4 years, researchers reported in the study, which was simultaneously published in The New England Journal of Medicine.
When researchers split participants into quintiles from the lowest to the highest levels of biomarker, they found the 30-year risk of CV disease rose along the quintiles.
Women with the highest levels of high-sensitivity CRP had a 70% greater risk of a major CV event than those with the lowest levels.
Participants with the highest levels of LDL cholesterol had a 36% increased risk of a major CV event compared with those who had the lowest levels, and for women with the highest levels of lipoprotein(a) there was a 33% increased risk of a first event compared with women with the lowest levels.
However, the greatest risk was among women who had the highest levels of all three biomarkers combined, with researchers finding they were 2.6 times more likely to have a major CV event compared with women with the lowest levels.
Commenting on the study, Dr Sonali Gnanenthiran, Cardiologist at The George Institute for Global Health and Concord Hospital in Sydney, said the ability to predict a woman’s risk of CV disease well beyond the currently available five- or 10-year CV risk calculators potentially represented an important opportunity for early intervention in women.
‘The study also demonstrated the importance of cumulative risk – i.e. exposure to risk even while young or middle-aged accumulates over a long period time,’ she said.
However, Dr Gnanenthiran, who is also a Senior Lecturer in the Faculty of Medicine at UNSW Sydney, cautioned there were limitations to the generalisability of the study, given the predominantly white and healthy study population.
There was also, as yet, no clear evidence that the screening models used in the current study would translate into improvements in population health.
‘For screening to be beneficial, it needs to be shown that it is costeffective and that there are effective treatments available that will lead to reduction in the burden of the disease,’ she said.
In particular, she noted, there were currently no treatments available in clinical practice to lower lipoprotein(a) levels, although trials were underway, and patients currently needed to pay out-of-pocket costs to access the test.
‘Risk assessment is evolving, and we need to watch this space as new biomarkers become available and are ultimately integrated into practice,’ she said.