A silent heart disease risk factor may explain why some women end up having heart attacks and strokes despite seeming like they are healthy, a new study suggests.
The analysis of 30 years of data from more than 12,000 women revealed that inflammation was comparable to high LDL cholesterol as a heart disease risk factor, researchers reported Friday at the European Society of Cardiology Congress meeting in Madrid. The results were simultaneously published in the European Heart Journal.
Measuring inflammation is not a standard part of screening in the United States and there are no outward signs that a person may have high levels.
Inflammation can raise a woman’s risk of a heart attack or stroke even when other risk factors — such as high cholesterol, smoking status and high blood pressure — aren’t an issue, said the study’s lead author, Dr. Paul Ridker, a preventive cardiologist at Mass General Brigham and Women’s Heart and Vascular Institute and a professor of medicine at the Harvard University Medical School.
“Half of all heart attacks and strokes occur in people who do not have any major risk factors,” Ridker said.
Dr. Anais Hausvater, a cardiologist and co-director of the Cardio-Obstetrics Research Program at NYU Langone Health, called the study “potentially practice changing.”
“Despite a growing body of evidence that inflammation is an incredibly important cardiovascular risk factor and the recommendation that most should be screened, the vast majority of women are not being screened,” said Hausvater, who was not involved with the research.
An inexpensive blood test for what’s known as high-sensitivity CRP can measure inflammation. Ridker said that in Europe it’s already the standard of care to measure hsCRP.
The new study used data from the Women’s Health Study, which was launched by the National Heart Lung and Blood Institute in the early 1990s.
At the outset, blood samples were collected from the women to measure cholesterol and hsCRP levels.
Of the nearly 28,000 women who provided a baseline blood test, 12,530 had no standard modifiable risk factors for heart disease, or “SMuRFs.” During 30 years of follow-up, there were 973 cardiovascular events — such as a heart attack or stroke — in this group. Levels of hsCRP were significantly higher among women who experienced them.
The new findings indicate that inflammation should be included in heart disease screenings, Ridker said. High inflammation can be treated with statins, but with a healthy cholesterol reading, these women would not qualify for a statin prescription.
A previous clinical trial found that women who do not have the standard modifiable risk factors could benefit from treatment with statins. That trial showed that women with high inflammation but no other risk factors saw a 38% reduction in serious cardiovascular events such as stroke and heart attack if they received statin therapy, Ridker said.
But if hsCRP isn’t measured, these women won’t get the lifesaving treatment they need, Ridker said. “The bottom line is that physicians will not treat what they don’t measure,” he said.
Hausvater said that screening should be routine for all women.
“This is another tool women should be offered to assess their risk,” she said. “I would say, based on this study, I would recommend that patients ask their physicians to check their hsCRP.”
Dr. Tania Ruiz, a cardiologist and an assistant professor of medicine at the Vanderbilt University Medical Center, agreed. “This is a very exciting study,” she said. “It’s the first large-scale study of hsCRP as a predictor of cardiovascular events in otherwise healthy women.”
“In recent years, we’ve learned more about the role of inflammation in the formation of plaques and plaque vulnerability,” Ruiz said.
Women with autoimmune diseases such as lupus may be more likely to have a high hsCRP score, Ruiz said. Otherwise, without testing, there’s no way to know.
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