Article Impact Level: HIGH Data Quality: STRONG Summary of New England Journal of Medicine, NEJMoa2405182. https://doi.org/10.1056/NEJMoa2405182 Dr. Paul M. Ridker et al.
Points
- A 30-year longitudinal study with 27,939 initially healthy U.S. women assessed the predictive value of three cardiovascular biomarkers—high-sensitivity CRP, LDL cholesterol, and lipoprotein(a)—for major cardiovascular events.
- Higher baseline levels of high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) were strongly associated with an increased risk of cardiovascular events, including heart attacks, strokes, and cardiovascular deaths.
- The highest quintile of high-sensitivity CRP had a hazard ratio of 1.70, LDL cholesterol had a hazard ratio of 1.36, and lipoprotein(a) had a hazard ratio of 1.33, indicating higher risk than the lowest quintiles.
- Over the 30-year study period, 3,662 first major cardiovascular events were recorded, emphasizing the long-term significance of these biomarkers in predicting risk.
- The study suggests integrating these biomarkers into long-term cardiovascular risk assessments to improve early prevention strategies beyond traditional 10-year risk models.
Summary
In a comprehensive longitudinal study involving 27,939 initially healthy U.S. women, researchers explored the predictive value of three cardiovascular biomarkers—high-sensitivity C-reactive protein (CRP), low-density lipoprotein (LDL) cholesterol, and lipoprotein(a)—over 30 years. Baseline measurements of these biomarkers were analyzed to assess their long-term association with the risk of major adverse cardiovascular events, including myocardial infarction, coronary revascularization, stroke, and cardiovascular death. Adjusted hazard ratios for these events were calculated across quintiles of each biomarker, with additional adjustments for age and competing risks to produce 30-year cumulative incidence curves.
The mean age of participants at the start of the study was 54.7 years. Over the following three decades, 3,662 first major cardiovascular events were recorded. The analysis revealed that higher baseline levels of high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) were significantly associated with an increased risk of cardiovascular events. Specifically, the highest quintile of high-sensitivity CRP showed a hazard ratio of 1.70 (95% confidence interval [CI], 1.52 to 1.90), LDL cholesterol had a hazard ratio of 1.36 (95% CI, 1.23 to 1.52), and lipoprotein(a) presented a hazard ratio of 1.33 (95% CI, 1.21 to 1.47), comparing the top to the bottom quintiles.
The study conclusively demonstrated that measuring high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) at baseline provides significant predictive value for the incidence of cardiovascular events over a 30-year span in women. These findings advocate for integrating these biomarkers into long-term cardiovascular risk assessments, suggesting that early-life interventions based on these biomarkers could effectively enhance strategies for the primary prevention of atherosclerotic events, extending beyond the traditional 10-year risk estimates.
Link to the article: https://www.nejm.org/doi/10.1056/NEJMoa2405182
References Ridker, P. M., Moorthy, M. V., Cook, N. R., Rifai, N., Lee, I.-M., & Buring, J. E. (2024). Inflammation, Cholesterol, Lipoprotein(a), and 30-Year Cardiovascular Outcomes in Women. New England Journal of Medicine, NEJMoa2405182. https://doi.org/10.1056/NEJMoa2405182
