High cholesterol is a less important indicator of heart attack and stroke in women than other subtle signs, a new study suggests.
Doctors have long used measurements of cholesterol, a fatty, waxy substance found in the blood, as an indicator of possible cardiovascular disease.
But a new study of 28,000 American women between the ages of 40 and 45 suggests that cholesterol is not the biggest predictor of heart attack and stroke risk.
Instead, high levels of a substance called high-sensitivity C-reactive protein (hs-CRP), detected at elevated levels in a blood test, may be a better indicator of dangerous levels of inflammation in the body.
Experts at Brigham and Women’s Hospital in Boston, Massachusetts, found that women with elevated hsCRP levels had a 70 percent higher risk of suffering a major cardiovascular event, such as a heart attack.
A new study of 28,000 American women aged 40 to 45 suggests that cholesterol is not the main indicator of risk for heart disease and stroke, a leading cause of death in Britain. File image
Our Future Health project results showing high cholesterol levels in the population based on a sample of 227,592 volunteers. Source: Our Future Health
In comparison, those with higher levels of bad cholesterol had only a 36 percent higher risk.
They also looked at another factor called lipoprotein(a), a type of fat in the blood that is determined by a person’s genes, and found that high levels were linked to a 33 percent increased risk.
But experts stressed that just because hsCRP is a stronger indicator of serious heart disease doesn’t mean people should ignore their cholesterol.
They presented their findings at the European Society of Cardiology Congress in London and published them in the New England Journal of MedicineThe authors said women with elevated levels of all three substances had a 2.6-fold increased risk of suffering a major adverse cardiovascular event, such as heart failure.
The results were even clearer when looking at stroke: women with elevated levels of all three substances had a 3.7 times higher risk of suffering a life-threatening event in the next 30 years, compared to those without them.
The results of the new study were based on blood tests that measured the three factors in 45-year-old women who had been followed since 1993.
Julie Buring, a Brigham epidemiologist and co-author of the new study, said the results should be a “wake-up call” for both doctors and women.
“Waiting until women are in their 60s and 70s to initiate heart attack and stroke prevention is a recipe for failure,” she said.
Dr. Paul Ridker, a cardiovascular disease prevention expert at Brigham and senior author on the study, added: “Doctors can’t treat what they don’t measure.”
‘To provide the best care for our patients, we need universal screening for inflammation, cholesterol and lipoprotein(a), and we need it now.
“In this way, we can tailor our treatments to the specific biological needs of each patient, thereby fulfilling our long-standing hope of offering truly personalized preventive care.”
When doctors talk about bad cholesterol, they’re specifically referring to a type called low-density lipoprotein, which is linked to dangerous fatty deposits around the arteries.
In contrast, “good” cholesterol, technically called high-density lipoprotein, collects excess cholesterol and carries it to the liver, where it breaks it down and removes it from the body.
For years Britons have been urged to control their bad cholesterol and reduce their risk by eating less fatty foods, getting more exercise and cutting down on tobacco and alcohol.
Drugs such as statins, a pill taken by around 8 million Britons every day, can also be prescribed to help lower cholesterol.
hsCRP levels can increase in response to causes of inflammation in the body unrelated to cardiovascular health, such as infection or injury, and things like obesity and smoking.
Tips for reducing these symptoms depend on the cause, but it is recommended to improve overall cardiovascular health by following a healthy diet and exercising regularly.
Some statins have also been found to reduce hsCRP levels.
The authors said their results supported the use of earlier and more aggressive interventions, both lifestyle changes and medications, to improve cardiovascular health.
Dr Ridker said: “While we still need to focus on essential lifestyle aspects such as diet, exercise and smoking cessation, the future of prevention will clearly include combination therapies that target inflammation and Lp(a) in addition to cholesterol.”
Cardiovascular disease causes around a quarter of all deaths in the UK, around 170,000 deaths each year.
That’s about 480 deaths a day, or one every three minutes, according to the British Heart Foundation.