This is a really interesting article on women and prediction of CAD with combination of HsCRP, LDL, Lp(a). The thing I find really unusual is the covariate adjusted hazard ratios were only 1.7 for the highest quintile. I would have thought it much higher.
4 Likes
Very interesting!
CONCLUSIONS
A single combined measure of high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) levels among initially healthy U.S. women was predictive of incident cardiovascular events during a 30-year period. These data support efforts to extend strategies for the primary prevention of atherosclerotic events beyond traditional 10-year estimates of risk.
https://www.nejm.org/doi/full/10.1056/NEJMoa2405182
1 Like
Yeah, a great find, DrFraser. I wonder why they limited this to women. Do men present differently vs these biomarkers wrt. predictive power?
I imagine we can’t simply extend these findings to men, but something like this for men would be nifty too, lol.
1 Like
I couldn’t find any guidance for optimal LDL or hsCRP values. Or is it just ‘the lower the better’?
1 Like
adssx
#5
3 Likes
Given that men in their 50’s have much more heart disease than women, I suspect the data would be stronger for men, but I’m a little surprised the worst 20% compared to the best best 20% only had a 1.7 fold difference, which is important, but I’d like to see the best 20% have a zero rate of disease. Clearly a lot more factors at play than just their 3 items.
3 Likes
I wouldn’t have guessed this finding.
“.… hsCRP was the stronger predictor than LDL-C or Lp(a)…”
2 Likes
Estrogen as an offsetting factor?
2 Likes
Metabolic health is aided by Estrogen - take this away at age 50, and metabolically inert fat (subcutaneous) in women moves to visceral fat. My experience, and my practice is to normalize hormones for life, and avoid this migration of fat into the abdomen.
Men on the other hand have earlier onset of all the bad things, including things like Non-Alcoholic Fatty Liver Disease … so we end up having about 10 years lead time on women in vascular disease … but adjust for that lead time - and I think @adssx pointed out to me, it is probably more like 15 years lead time … but then women have escalating rates of bad outcomes.
This is precisely why, I’m increasingly thinking serial imaging to see if there is disease present makes a lot of sense. I see patients in the ER who one might think would be disease free, and they are having a myocardial infarction or stroke. Could this have been predicted? Absolutely … but do our blood markers add enough sensitivity to know if we have disease or not? Absolutely not.
This is where I think everyone who wants to live a long time, and has at least some resources needs to consider either a Whole Body MRI/MRA neck/head OR CT Cardiac Calcium PLUS carotid intimal thickeness.
Thinking blood markers are sufficient is significantly disproven by this study. Do good blood markers help? Absolutely - but I’d like to see 100% protection from events, not a risk reduction of 1.7. So seeing do you have vascular disease … is incredibly important as it will be the #1 killer and disabler for all of us.
5 Likes
