A study in the New England Journal of Medicine (one of the most reliable journals in medicine) followed 28,000 healthy women over a period of 30 years and found that a single test that includes low density (LDL) cholesterol, C-reactive protein (marker for inflammation), and a specialized fat particle called lipoprotein (a) was able to tell who would get heart disease, stroke, need for heart surgery, and even predicted death over a 30-year period.
Women with higher CRP, LDL cholesterol, and lipoprotein (a) had 2-3 times greater chance of having a stroke, heart attack, or death from cardiovascular causes. Interestingly, even those who started a cholesterol lowering medication called a statin, half of these still had a stroke, heart attack, or death suggesting that medications that lower cholesterol alone is not enough to prevent disease. We need to also focus on lifestyle, the inflammation in our bodies, and stress reduction.
Why is this study important?
This study is first to show that a single “test,” taken 30 years ago can predict the future risk of cardiovascular (heart and vessel) disease. This is critical because it allows us enough time to make a real difference in our cardiovascular health by changing our lifestyle, and if needed starting new medications to live longer and healthier.
It is important as heart disease and stroke are the “silent killer,” and if left untreated accounts for over half of the deaths yearly in the U.S.
What is Cardiovascular disease?
Cardiovascular disease (disease of heart and vessels) is the buildup of plaque or fatty deposits in the vessels of our bodies that can begin in early childhood and progresses rapidly between 40 and 60 years of age. Plaques are made up of cholesterol, fats, calcium, and blood clotting substances. The more plaque we have (called atherosclerosis) the harder it is for blood to flow to our heart and brain, and if goes untreated and the vessels build up too much plaque this can lead to a heart attack and stroke.
Is this new test routinely checked with my labs?
Not exactly. The standard cholesterol panel that you doctor orders includes only low-density lipoprotein (LDL), and total cholesterol, and the lab uses this information and calculates a risk ratio to determine your chances of getting heart disease and stroke based on these values. This value is an important but can only predict your risk of heart attack and stroke up to 10 years in the future.
To predict your risk at 30 years, you will need to ask your doctor to add to the standard cholesterol panel a high sensitivity C-reactive protein (CRP), and lipoprotein (a). Based on the results of the 3 values, LDL cholesterol, CRP, and lipoprotein (a) your doctor can now predict your risk of heart disease at 30 years.
What is C-reactive protein or CRP?
C-reactive protein (CRP) is a protein made in the liver that shows how much inflammation is in your body. They have found that “too much inflammation,” can worsen or cause heart disease especially when the levels are in the highest ranges or quartiles. The inflammation can affect the plaque in the vessel allowing it to grow larger and blocking the flow of the blood to the brain and heart.
In general, CRP higher than 2 mg/L may indicate a higher risk of heart disease. The plaque that builds up in the vessels of your heart and body is very sensitive to “inflammation,” and stress so currently research is looking at the best ways to reduce these levels.
Best way currently to reduce CRP levels and stop heart disease includes medications mostly statins (decreases inflammation), and exercise. There is new evidence that colchicine that is used to treat gout can also reduce inflammation and risk of atherosclerosis. Interestingly, colchicine has been used since ancient time in Egypt to treat inflammation.
What is Lipoprotein (a) and why is it important?
Lipoprotein (a) is a special type of cholesterol molecule associated with developing blockage of the vessels of the body that can lead to heart attacks and stroke. High levels have been associated with heart disease.
It is unique in that the amount of lipoprotein (a) is determined by the genes of your biological parents and stays constant throughout your life. So, what you have as a child is what you have as an adult.
There are medications in the pipeline that are under development to directly reduce this type of cholesterol but for now medications called statins (reduces the amount of cholesterol made), PCSK9 inhibitors (reduces cholesterol by blocking PCSK9), and aspirin may help.
How can I stop from getting heart disease and stroke?
Best way of preventing heart disease, stroke, and risk of death is first to know if you are at risk. In the U.S., every year over half of all deaths is caused by heart disease and stroke, and more than 50 % of those who died did not know they were at risk. That is why it is called the “silent,” killer.
It is also important that diseases that lead to this silent killer including diabetes, and hypertension are identified and treated by your doctor.
In addition to the routine cholesterol panel (includes LDL cholesterol), we recommend asking your doctor or provider to include a high sensitivity CRP and lipoprotein (a). Important to also check with your insurance company to be sure these tests are covered as can be expensive.
If the levels are normal your risk is lower for heart disease but if any of the levels are high, you may want to start lifestyle modification including stopping smoking, regular exercise, embracing a diet low in saturated fats and cholesterol, stress reduction, and weight loss. If the levels are very high, you may need to start medications.
If you have any questions, please reach out and AskDoctorH. We are here to help.
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