WOMEN should begin evaluating their heart disease risks and consider preventive medications in their 30s, rather than waiting until after menopause, according to researchers who published a new study on Saturday.
The study, presented at the European Society of Cardiology annual meeting in London, demonstrated for the first time that simple blood tests can estimate a woman’s cardiovascular disease risk over the next 30 years.
"This is good for patients first and foremost, but it is also important information for (manufacturers of) cholesterol-lowering drugs, anti-inflammatory drugs, and lipoprotein(a)-lowering drugs – the implications for therapy are broad," said Dr Paul Ridker of Brigham and Women’s Hospital in Boston, who led the study.
Current guidelines generally recommend that women not be considered for preventive therapies until their 60s or 70s. However, Ridker emphasised that the new data clearly indicate the need for a change in these guidelines, saying, “We must move beyond discussions of 5 or 10 year risk."
The study involved 27,939 participants from the long-term Women’s Health Initiative study, who had blood tests between 1992 and 1995 for low-density lipoprotein cholesterol (LDL-C or “bad cholesterol”), which are commonly part of routine care.
They were also tested for high-sensitivity C-reactive protein (hsCRP) – a marker of blood vessel inflammation – and lipoprotein(a), a genetically determined type of fat.
The findings revealed that women with the highest levels of LDL-C had a 36 per cent higher risk of major cardiovascular events over the next 30 years, compared to those with the lowest levels. Similarly, women with the highest levels of hsCRP had a 70 per cent higher risk, and those with the highest levels of lipoprotein(a) had a 33 per cent higher risk.
Women with all three markers in the highest range were found to be 2.6 times more likely to experience a major cardiovascular event and 3.7 times more likely to suffer a stroke over the next three decades, as reported in The New England Journal of Medicine, published alongside the presentation at the meeting.
“The three biomarkers are fully independent of each other and tell us about different biologic issues each individual woman faces,” Ridker said. He added, “The therapies we might use in response to an elevation in each biomarker are markedly different, and physicians can now specifically target the individual person’s biologic problem.”
While drugs to lower LDL-C and hsCRP are widely available, such as statins and certain medications for high blood pressure and heart failure, drugs to reduce lipoprotein(a) levels are still under development by companies like Novartis, Amgen, Eli Lilly, and London-based Silence Therapeutics.
In some cases, lifestyle changes like exercising and quitting smoking can also be beneficial.
Most of the women in the study were white Americans, but Ridker noted that the findings could have an even greater impact among Black and Hispanic women, who have a higher prevalence of undetected and untreated inflammation.
“This is a global problem,” he said, calling for universal screening for hsCRP and lipoprotein(a), similar to the existing universal screening for cholesterol.
(Reuters)
