3 Lab Tests Predict Heart Disease Risk

• Heart disease is the number one killer in the US

• An ounce of prevention is worth a pound of stents

• 30 year risk prediction is the new grail

• Three lab tests (see below) predict risk over 30 years

• Inflammation is a critical driver of coronary disease

Estimated reading time: 5 min

Public enemy #1: Cardiovascular disease

Heart disease remains the leading cause of death in the United States. Alarmingly, according to the American Heart Association, nearly half of US adults have some form of heart disease. As one of my previous colleagues mused after finishing his interventional cardiology fellowship, “there’s a war on hearts going on out here… and we’re losing.”

This is a war that will be impossible to win from the front lines, with stents and surgery. For that we need to focus on prevention.

Holy grail in sight?

This August, the New England Journal of Medicine published one of the most important recent papers in cardiovascular prevention. This paper provided critical insight into what has become a sort of holy grail: estimating a 30 year risk of heart disease. (Prior models typically had a time horizon of 10 years- too short until its too late.) The data comes from nearly 30,000 female healthcare workers enrolled in the early 1990s and reported results after a 30 year follow up. Very rarely do we get studies of such a size and over such a long period of time.

hs-CRP, LDL and Lipoprotein (a) predict 30 year risk

The level of three simple lab tests measured one time had strong correlations with the development of heart disease over the next 30 years. Specifically, they measured high-sensitivity C-reactive protein (hs-CRP), Low Density Lipoprotein (LDL) and Lipoprotein (a) (Lp(a)). Study subjects were divided into quintiles- 5 groups for each blood test ranked from lowest to highest. The risk of heart disease increases along with the levels of hs-CRP and LDL. For lipoprotein (a), the highest quintile was at higher risk compared to all of the four lower groups.

Having just an hs-CRP level in the highest quintile increased the 30 year risk of a heart problem by ~70%.

In about 1% of the study population all three of these lab tests fell in the highest quintile, and this group of 1%ers had an almost four times higher risk of coronary disease developing over the 30 year study period compared to those with all lab values in the lowest quintile. Ouch.

Inflammation: Moving beyond the lipid panel

For decades doctors have focused on the typical lipid panel- HDL, LDL, Triglycerides, etc. It is time to refine our risk palate. I had previously discussed the importance of lipoprotein (a), and it might be time to more regularly incorporate hs-CRP.

Anecdotally, this test is not widely used, in part due to concerns that it could be influenced by numerous factors other than arterial inflammation leading to a [shrug emoji] when it is elevated. The above study provides valuable evidence that even a spot check of hs-CRP could provide significant predictive value. It shows that beyond cholesterol, we should see inflammation as an important target in the prevention of heart disease.

Do this:

• At your next visit, ask your doctor about getting a lipoprotein (a) and an hs-CRP added to the blood draw for you lipid panel

• In the mean time, check out this 30 year risk calculator the AHA rolled out

• Stay tuned for more about hs-CRP and inflammation in the future.

• Exercise and eat the correct amount of pizza

References

• Ridker et al. “Inflammation, Cholesterol, Lipoprotein(a), and 30-Year Cardiovascular Outcomes in Women” NEJM 2024

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As always, health is personal, and for personalized advice please consult your healthcare professional.