Can a Blood Test Warn You of a Heart Attack?
Heart disease remains the top killer of American women. Yet many are not aware that cardiovascular events account for one in every five female deaths.
Now, three biomarkers that can be easily measured through a blood test may alert women — and their physicians — about the potential risks of a heart attack or a stroke decades before such a problem strikes.
According to a recent study, these blood biomarkers improve the prediction of heart disease risk instead of only referring to the traditional risk calculators now in use.
Cardiologists hope that, when used with traditional measures, the combined figures will nudge women to take preventive action to improve cardiovascular health.
This could potentially save thousands of life. Now, more than 310,000 women die of heart disease every year and about 80% of women between 40 and 60 years of age are living with at least one risk factor, according to the U.S. Centers for Disease Control and Prevention.
“It provides us with the necessary tools to integrate all of the information” to create a more accurate risk profile for female patients, says Claudia Martinez Bermudez, M.D., a clinical and interventional cardiologist at the University of Miami Health System. “For too long, because of the gender gap in studies, we have underestimated women’s risk of heart disease, and as a result, we have underdiagnosed and undertreated.”
Historically, physicians have used certain well-known factors to calculate the risk of a patient developing cardiovascular disease.
These include:
- high LDL (or “bad”) cholesterol
- high blood pressure
- extra weight or obesity
- high body-mass index
- use of nicotine
- sedentary lifestyle
- diabetes
These criteria were applied to both men and women, namely because the preponderance of studies had been done on men. As pressure to develop accurate gender-specific measures grew, more research began to focus on women. Recent studies have shown that adverse pregnancy outcomes, such as hypertension during pregnancy, gestational diabetes, preterm delivery, and pregnancy loss, also contribute to developing cardiovascular disease later in life.
The latest groundbreaking research, published in the New England Journal of Medicine and presented at a European Society of Cardiology conference in London, also focused solely on women. Dr. Martinez Bermudez says this is a “significant” step in addressing the differences between men and women regarding cardiovascular disease risk.
Funded by the National Institutes of Health, the research followed about 40,000 women for 30 years, beginning in the 1990s. Participants were health professionals, overwhelmingly white, with an average age of 55. About 25% had high blood pressure and 14% had at least one parent who had had a heart attack before 65. More than 12% smoked and 3% had a history of diabetes. Of the 40,000 who enrolled in the study, 28,000 provided blood samples that were tested.
Researchers found that three factors were major contributors to block arteries later in life, even among currently healthy women:
- Low-density lipoprotein, or LDL. Known as the “bad” cholesterol, LDL has long been a standard marker of heart risk. That’s because it measures the buildup of plaque in the arteries.
- High-sensitivity CRP. This measures inflammation in blood vessels, which is a result of the immune system’s response to cholesterol buildup. When cholesterol begins to clog arteries, it forms crystals that our body tries to clear. That process of elimination produces CRP, or c-reactive protein.
- LP(a). Similar to LDL, this lipid forms plaques that plug our arteries. It’s mostly an inherited risk factor. In fact, seemingly healthy people living a healthy lifestyle with normal LDL can still develop artery blockage because of genetics.
Dr. Martinez Bermudez says LDL is commonly tested during an annual physical, but the other two markers are usually not. Tracking high-sensitivity CRP is left up to the health provider, and LP(a), a newer measure, is rarely ordered in primary care bloodwork. Some countries have universal screenings for these biomarkers, but not the United States. “Now that we know how these factors work together, women should definitely request they be tested,” she adds.
These numbers can help patients and physicians plan to ameliorate these risks long before any signs pop up.
The researchers concluded: “These data support efforts to extend strategies for the primary prevention of atherosclerotic events beyond traditional 10-year estimates of risk.“
While each factor contributes to heart health risk, high levels of all three are exponentially more dangerous. For example, when researchers followed up with participants at the end of the study period, they found that those with high levels of LDL, high-sensitivity CRP and LP(a) were almost three times more likely to have a major heart event and about four times more likely to suffer a stroke.
Individually, each biomarker was also associated with a higher risk of cardiovascular disease. Inflammation, or high-sensitivity CRP, proved to be the strongest factor, with a 70% higher likelihood of a major heart event for women with the highest levels of that protein.
Though encouraged by the applicable data in the study, Dr. Martinez Bermudez says more research needs to be done.
“The study looked primarily at white women,” she says, “but we need to learn more about Hispanics and African-American women, about different minorities and socioeconomic levels.”
She would also like to see more research into the inherited risk factor measured by LP(a) and how it plays out in the broader scenario of potential therapies. Currently, patients with high LDL can take statins to control their cholesterol. In addition, colchicine, an old gout medicine, was approved by the U.S. Food and Drug Administration for vascular inflammation in 2023. Treatment for high levels of LP(a), on the other hand, is still limited and under investigation.
So far, lipoprotein apheresis, in which a machine removes LP(a) and LDL from the blood, is the only therapy approved by the FDA.
However, researchers have reported that a phase 2 trial shows that muvalaplin, a new oral medication, is safe and effective in lowering high levels of LP(a).
That said, there are many preventive measures a person can take to offset the risks of cardiovascular disease. Dr. Martinez Bermudez directs her patients to follow the American Heart Association’s Life’s Essential 8 health goals. These focus on eating a healthy diet, participating in physical activity, quitting nicotine, getting enough sleep, controlling cholesterol, and managing weight, blood glucose levels and blood pressure.
“The sooner we make changes to our lifestyle,” she says, “the healthier we will feel and the better quality of life we can have to have fun and enjoy life.”
Ana Veciana-Suarez is a regular contributor to the University of Miami Health System. She is an acclaimed author and journalist who has worked at The Miami Herald, The Miami News, and The Palm Beach Post.
Tags: blood biomarkers, cardiovascular risk, Claudia Martinez-Bermudez, early detection, heart disease, Preventive cardiovascular program
