If people can get advanced warnings that they are at high risk for certain diseases, they might be able to implement lifestyle changes that can reduce the risk of those diseases, or receive treatments sooner that can reduce the severity of disease if it starts. New research has shown that assessing inflammation and fat levels in middle-aged women could help identify those who are at risk for cardiovascular disease, and improve health outcomes for those people. This study, which was reported in the New England Journal of Medicine (NEJM), determined that measuring levels of an inflammation biomarker called C-reactive protein (CRP) and two types of fats, or lipids in the bloodstreams of women, can predict their risk of cardiovascular disease decades later.
“We can’t treat what we don’t measure, and we hope these findings move the field closer to identifying even earlier ways to detect and prevent heart disease,” said study co-author Paul M. Ridker, MD, MPH, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital.
In this work, 27,939 women volunteers provided blood samples and health data. A group with an average age of 55 began the study between 1992 and 1995 and were followed for thirty years; there were heart attacks, strokes, circulation-related surgeries, or cardiovascular-associated deaths among 3,662 participants during that time period. The investigators wanted to know whether measurements of CRP, and two lipids: low-density lipoprotein (LDL) cholesterol, and lipoprotein(a) or Lp(a), could predict those health events.
The researchers showed that those with the highest LDL levels had a 36 percent increase in the risk of heart disease compared to women with the lowest LDL levels. For the other biomarkers, the highest Lp(a) carriers had a 33 percent risk increase, and the highest CRP carriers had a 70 percent risk increase compared to those with the lowest levels.
If the measurements of CRP, LDL, and Lp(a) were considered together, those with the highest levels had 1.5 times higher stroke risk and a 3 times higher coronary heart disease risk compared to the women with the lowest levels of these markers.
The investigators noted that while this study was focused on women, the results are probably similar for men.
“In recent years, we’ve learned more about how increased levels of inflammation can interact with lipids to compound cardiovascular disease risks,” said Ahmed A.K. Hasan, MD, PhD, a medical officer and program director at the NIH. “This helps explain why lower levels are often better.”
Immune cells are usually tasked with fighting infection or repairing wounds. But they can also react to a buildup of cholesterol or plaques by triggering inflammation. A hyperinflammatory environment can then be created, leading to the formation of larger plaques and potentially, ruptures that can cause serious cardiovascular problems and events.
The researchers noted that healthy habits, like managing stress, avoiding or quitting smoking, getting regular physical activity, and eating foods that are lower in added sugars and fats, can help prevent these health problems. Better habits, or bad ones, can have a cumulative impact over a lifetime, so it's best to take these steps as soon as possible and stick to them. Medications like statins that help control cholesterol levels, can also help people who have difficulties.
Screening recommendations for the biomarkers in this study can vary, however, and are often left to clinicians who consider factors such as family histories. This study may help make these tests more common as screening tools, however.
Sources: National Institutes of Health (NIH), New England Journal of Medicine (NEJM)