Study finds simple blood test could predict a person’s heart disease risk 30 years out

A recent study published in the New England Journal of Medicine suggests that a different method for conducting a routine blood test could potentially forecast an individual’s risk of developing heart disease over the next 30 years.

Traditionally, doctors have relied on cholesterol levels, particularly LDL or “bad” cholesterol, to assess cardiovascular risk. However, experts argue that this approach overlooks other significant and often unnoticed risk factors that can be detected through comprehensive blood testing.

“We have other biomarkers that tell us about other kinds of biological problems our patients who are destined to have cardiovascular disease are likely to have,” said lead study author Dr. Paul Ridker, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in Boston.

Ridker and his team discovered that, in addition to LDL cholesterol, two other factors—lipoprotein (a) or Lp(a), a type of blood fat, and an inflammation indicator—are significant predictors of a person’s risk of heart attack, stroke, and coronary heart disease. These findings were presented at the European Society of Cardiology Congress 2024 in London.

The study involved an analysis of data from nearly 30,000 U.S. women who participated in the Women’s Health Study. The average age of the women at enrollment was 55 years between 1992 and 1995.

Over the subsequent 30 years, around 13% of participants experienced a heart attack or stroke, underwent surgery for a narrowed or blocked artery, or died from heart disease.

While the research focused on women, Ridker suggested that the findings likely apply to men as well. The deliberate emphasis on women was due to their under-treatment and underdiagnosis for this largely preventable disease.

At the start of the study, all women underwent blood tests to measure their levels of LDL cholesterol, Lp(a), and C-reactive protein (CRP), an inflammation marker. The study found that these measurements individually as well as combined could predict a woman’s heart health over the following three decades.

Women with high levels of LDL cholesterol had a 36% higher risk of heart disease compared to those with low levels. Similarly, high levels of Lp(a) indicated a 33% increased risk while elevated CRP levels were associated with a 70% higher risk for heart disease.

When these three factors were considered together, women with the highest levels were 1.5 times more likely to experience a stroke and over three times more likely to develop coronary heart disease over the next 30 years compared to those with the lowest levels.

All of the markers have been individually linked to higher risk of heart disease, but “all three represent different biological processes. They tell us why someone is actually at risk,” Ridker said.

Traditional risk factors for heart disease include obesity, diabetes, high blood pressure and high cholesterol levels. Testing for Lp(a) and CRP can reveal less obvious risk factors.

“You can have no traditional risk factors and just by having that high Lp(a), you are at higher risk,” said Dr. Rachel Bond, system director of women’s heart health at Dignity Health in Arizona, who was not involved with the study.

Bond recommended that individuals undergo an Lp(a) test at least once in their lifetime, and if they have heightened levels at any point, it will persist for life. However, there is an exception: post-menopausal women may develop elevated Lp(a) and may consider retesting their levels at that stage, according to Bond.

In contrast, LDL cholesterol and CRP levels can fluctuate over a person’s lifespan. Ridker advocates for physicians to conduct a comprehensive blood test including these three factors when patients are in their 30s or 40s, aiming to identify potential overlooked risk factors early on so that intervention can be implemented in time.

Despite the importance of exercise, healthy eating, and abstinence from smoking, individuals with already elevated levels of Lp(a), LDL, and CRP will likely require medication, as stated by Dr. Steven Nissen, the chief academic officer of the Heart, Vascular and Thoracic Institute at the Cleveland Clinic. Dr. Nissen was not involved in the study.

“We can’t expect lifestyle interventions are going to do the job alone for most people,” Nissen said.

The study had several limitations that future research may address, including a lack of racial and ethnic diversity, which plays an important role in a person’s risk for heart disease. Nearly all of the participants — 94% — were white.

Nissen also noted that the study stopped measuring Lp(a) levels once they passed a certain threshold.

“The highest levels of lipoprotein (a) in this study weren’t even high enough to reach the clinical threshold at which a patient would be treated,” he said. “It tends to underestimate the risk of lipoprotein (a).”

Dr. Kunihiro Matsushita, a professor of epidemiology at Johns Hopkins Bloomberg School of Public Health, who specializes in cardiology, said that while inflammation is definitely important, “that doesn’t mean CRP is the best marker for predicting cardiovascular disease risk.”