A combination of high levels of lipoprotein (Lp) a, remnant cholesterol and high-sensitivity C-reactive protein (CRP) significantly increases a person’s risk of heart attack according to new research.
“Each of the blood tests on its own indicate only a modest increase in heart attack risk, however, when we found elevated levels for all three, the risk of heart attack was nearly three times higher,” said Richard Kazibwe, MD, assistant professor at Wake Forest University School of Medicine, who presented the work at the American Heart Association conference in New Orleans this week in a press statement.
“These biomarkers work together like pieces of a puzzle. One piece cannot show the full picture, yet when combined, we can see a much clearer and more complete depiction of heart attack risks.”
Both Lp(a) and remnant cholesterol can lead to plaque building up in the arteries if levels are too high. CRP measures how much inflammation there is in the body, which can also contribute to heart disease.
In this study, the researchers studied information collected from 306,183 participants of the UK Biobank (55% female), aged 56 years on average on enrollment, who had no cardiovascular disease when enrolled and who also had early measures of the three biomarkers taken. Remnant cholesterol was calculated as the sum of total cholesterol minus low density lipoprotein and high density lipoprotein cholesterol.
Over a median of 15 years follow up, 10,824 people in the group had heart attacks. When the participants were sorted into quintiles of biomarker levels, the researchers found that the incidence of heart attack increased for each biomarker when comparing the top with the bottom quintile. This risk increased significantly if more than one of the biomarkers was in the top quintile.
Comparing the top versus the bottom quintile for Lp(a), remnant cholesterol and high sensitivity CRP, risk was increased by 9%, 14%, and 8%, respectively.
When comparing individuals with no biomarkers in the top quintile to those with one, two or three in the top quintile, risks for myocardial infarction increased by 1.45-, 2.14- and 2.83-fold, respectively.
“A clear pattern confirmed that these biomarkers are related…Evaluating the combined results of all three blood tests may help health care professionals act more quickly and provide tailored care for people with the highest risk,” said Kazibwe. “In addition, guidance that encourages healthy lifestyle changes or initiating treatment, such as medication to lower cholesterol and/or blood pressure, are keys to reducing risk and preventing heart attacks.”
Testing for the three biomarkers assessed in this study is not standard in many places, but the tests are available on request from many labs so the researchers believe it would be fairly easy to roll out testing on a larger scale. Although this would involve some extra costs, these would arguably be compensated for if future heart attacks could be prevented by early risk assessment.
“The three biomarker tests represent part of a larger toolkit for assessing heart attack risks that also include genetic risk scores and coronary artery calcium scans. The future challenge will be learning how to combine all this information to help health care professionals make personalized decisions for each patient,” concludes Kazibwe.
