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Women’s risk of heart disease and the need to take preventive drugs should be evaluated when they are in their 30s, not after menopause as is the practice now, said researchers who published a study on Saturday.
Presenting the findings at the European Society of Cardiology annual meeting in London, he said the study showed for the first time that simple blood tests made it possible to predict women’s risk of heart disease over the next three decades.
“First of all, this is good for patients, but it’s also important information for manufacturers of cholesterol-lowering drugs, anti-inflammatory drugs and lipoprotein-lowering drugs — the implications for medicine are broad,” said study leader Dr. Paul Ridker of Brigham and Women’s Hospital in Boston.
Current guidelines “suggest to clinicians that women generally should not be considered for preventive treatment until their 60s and 70s. These new data … clearly demonstrate that our guidelines need to change,” Ridker said. “We must move beyond discussions of 5- or 10-year risk.”
The 27,939 participants in the long-term Women’s Health Initiative Study had blood tests for low-density lipoprotein cholesterol (LDL-C or “bad cholesterol”) between 1992 and 1995, which is already a part of routine care.
They also underwent testing for high-sensitivity C-reactive protein (hsCRP) — a marker of blood vessel inflammation — and lipoprotein(a), a type of genetically determined fat.
Compared with the risk in women with the lowest levels of each marker, the risk of major cardiovascular events, such as heart attack or stroke, over the next 30 years was 36% higher in women with the highest levels of LDL-C, 70% higher in women with the highest levels of hsCRP, and 33% higher in women with the highest levels of lipoprotein(a).
Women who had all three markers in the highest category were 2.6 times more likely to have a major cardiovascular event over the next three decades and 3.7 times more likely to have a stroke, according to the study, published in the New England Journal of Medicine along with the presentation at the meeting.
“These three biomarkers are completely independent of each other and tell us about different biological issues facing each woman,” Ridker said.
“The treatments we can adopt in response to an increase in each biomarker are clearly different, and clinicians can now specifically target each individual’s biological problem.”
While drugs that lower LDL-C and hsCRP are widely available — including statins and some pills for high blood pressure and heart attack — drugs that lower lipoprotein(a) levels are still in development by companies including Novartis, Amgen, Eli Lilly and London-based Silence Therapeutics.
In some cases, lifestyle changes such as exercising and quitting smoking may be helpful.
Most of the women in the study were white Americans, but the findings “will have an even greater impact on black and Hispanic women, in whom the prevalence of overlooked and untreated inflammation is even higher,” Ridker said.
“This is a global problem,” he said. “We need universal screening for hsCRP … and lipoprotein(a), just as we already have universal screening for cholesterol.”
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