Combination biomarkers foretell long-term cardiovascular risk in women

A single combined measure of high-sensitivity C-reactive protein (CRP), low-density lipoprotein (LDL) cholesterol, and lipoprotein(a) levels may predict the incidence of cardiovascular events over a 30-year period, as shown in a study.

Researchers measured high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) levels at baseline in 27,939 initially healthy women (mean age 54.7 years) in the US. These women were subsequently followed for 30 years for the incidence of a first major adverse cardiovascular event, the primary study endpoint. The endpoint was a composite of myocardial infarction, coronary revascularization, stroke, or death from cardiovascular causes.

A total of 3,662 first major cardiovascular events occurred during the 30-year follow-up. The risk of cardiovascular events over a 30-year period was higher among women in higher quintiles of baseline high-sensitivity CRP, LDL cholesterol, and lipoprotein(a).

Comparing women in the top vs the bottom quintile, the covariable-adjusted hazard ratios for the primary endpoint were 1.70 (95 percent confidence interval [CI], 1.52–1.90) with high-sensitivity CRP, 1.36 (95 percent CI, 1.23–1.52) with LDL cholesterol, and 1.33 (95 percent CI, 1.21–1.47) with lipoprotein(a). These estimates were consistent with those obtained for coronary heart disease and stroke.

Of note, while each biomarker independently contributed to the overall risk, the combination of all three biomarkers yielded the greatest discriminatory power for risk prediction.

The findings back efforts to extend strategies for the primary prevention of atherosclerotic events beyond traditional 10-year estimates of risk.