newest research on cholesterol

• Cholesterol & Triglycerides
• Cholesterol
• Triglycerides
• Causes & Risks
• Tests & Diagnosis
• Overview of Treatment
• Drug Therapy
• Complementary & Alternative Treatment
• Diet & Exercise
• Mental & Emotional Health
• Complications
• Appointment Prep
• View Full Guide

Cholesterol: Latest Research

High cholesterol raises your risk of heart disease , heart attack , and stroke . A healthy diet and lifestyle can improve your levels. Medication can help, too. Still, doctors and scientists keep studying cholesterol to see what else they can learn about it.

Here’s some progress they’ve made in the ways they think about, prevent, and treat high cholesterol.

A More Personal Approach

Doctors used to think everyone’s cholesterol level should be about the same. Now, your doctor will look at your numbers along with other risk factors you have for heart disease. Those factors include blood pressure , blood sugar , age, and weight . The higher your risk for heart issues, the lower your doctor may suggest you try to get your cholesterol levels .

Prescription for Exercise

If you have high cholesterol and mildly high blood pressure , but you have a low overall risk of heart disease, your doctor may not prescribe medication right away. New guidelines from the American Heart Association advise sitting less and moving more as the first treatment.

Physical activity can reduce LDL (low-density lipoprotein, or “bad”) cholesterol by 3 to 6 milligrams per deciliter (mg/dL) in your blood. It also lowers your blood pressure.

About 150 minutes of moderate exercise per week is ideal. But you could see a difference in your cholesterol levels with as few as 5 to 10 minutes of movement each day.

Beyond Statins

Doctors often prescribe statins to treat high cholesterol, but not everyone does well on these drugs. People who don’t respond to this type of medicine, or who have unpleasant side effects, now have some other options, such as:

• PCSK9 inhibitors: PCSK9 is a protein that your liver makes. The more you have, the harder it is for your body to get rid of LDL cholesterol . A new class of drugs called PCSK9 inhibitors can block PCSK9. That way, it won’t interfere with cholesterol. You can take these medications by themselves or with statins . You get them through a shot, usually about every 2 weeks.

If you have a genetic condition called familial hypercholesterolemia , PCSK9 inhibitors may work better for you than statins do.

• SiRNA therapy: SiRNA (small interfering RNA) therapy can treat some health conditions by changing how some of your genes work. A new medication called inclisiran ( Leqvio ) uses this technology to treat adults with heterozygous familial hypercholesterolemia (HeFH) or clinical atherosclerotic cardiovascular disease (ASCVD) who need additional LDL lowering. It lowers your LDL levels by disrupting the gene that makes PCSK9. Inclisiran comes in the form of shots, taken several months apart. You can use this medication along with other cholesterol-lowering treatments or alone.
• Bempedoic acid: Like statins, this new medication makes it harder for cholesterol to form in your body. Bempedoic acid, which is a pill you swallow, may lower your LDL levels by up to 15%. For now, you can get a prescription only if you have a family history of high cholesterol or you have atherosclerotic cardiovascular disease (ACD).

Nanotech That ‘Eats’ Plaque

Cholesterol can cause fatty deposits called plaque to form inside your arteries . Over time, it can start to block your blood flow. This condition, called atherosclerosis , raises your risk of heart problems and stroke . Scientists have recently created a nanoparticle -- a tiny object that the naked eye cannot see -- to eat away at this waxy buildup. It’s still in testing mode, but in the future, a drug that contains this nanoparticle could be part of atherosclerosis treatment.

Gut Health Could Help

Researchers have thought for some time that gut health plays a role in cholesterol levels , but it hasn’t been clear exactly how. But they now know that probiotics (“good” live bacteria) and prebiotics (which feed useful germs in your gut) can lower LDL cholesterol and triglycerides , another type of blood fat. These gut bacteria may also increase high-density lipoprotein (HDL, or “good”) cholesterol.

Talk to your doctor if you’re interested in trying probiotics or prebiotics. The amount you need in order to get results is still under review, and too much could lead to an upset stomach .

Top doctors in ,

Find more top doctors on, related links.

• Cholesterol & Triglycerides News
• Cholesterol & Triglycerides Reference
• Cholesterol & Triglycerides Slideshows
• Cholesterol & Triglycerides Quizzes
• Cholesterol Management Blog
• Find a Doctor
• WebMDRx Savings Card
• Atherosclerosis
• Diet & Nutrition
• Heart Disease
• High Blood Pressure
• High Triglycerides
• Living Healthy
• Metabolic Syndrome
• My Medicine

New Cholesterol Guidelines Could Drastically Reduce Statin Use for Millions

Adopting new PREVENT equations could lead to a significant reduction in statin recommendations, impacting 40% of currently eligible U.S. adults, and highlights the importance of precise risk assessment and patient communication in cholesterol management.

If national guidelines were updated to include a new risk equation, approximately 40% fewer individuals may qualify for cholesterol-lowering statins to prevent heart disease, suggests a study involving researchers from the University of Pittsburgh , Beth Israel Deaconess Medical Center , and University of Michigan . The research, published in JAMA Internal Medicine , explores the implications of broadly implementing the PREVENT equations, introduced by the American Heart Association in November 2023. These equations are intended to refine the tools doctors use to estimate a patient’s 10-year risk of a heart attack or stroke.

At a population level, the number of adults recommended for statins could decrease from 45.4 million to 28.3 million. At the same time, the study showed that most people who would be recommended to take statins are not currently taking them.

“This is an opportunity to refocus our efforts and invest resources in the populations of patients at the highest risk,” said lead author Dr. Timothy Anderson, M.D., M.A.S., a primary care physician at UPMC and health services researcher and assistant professor of medicine at Pitt.

Methodology of the Study

For their analysis, the team used nationally representative data from 3,785 adults, ages 40 to 75, who participated in the National Health and Nutrition Examination Survey from January 2017 to March 2020. The researchers estimated the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) using the Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations and compared the results to risk estimated using the previous tool, known as Pooled Cohort Equations (PCE). The PREVENT equations were developed by the American Heart Association to more accurately represent risk across the current U.S. population, as the PCE equations were based on patient data that were decades old and lacked diversity.

PREVENT also reflects more recent insights into the biology of ASCVD. Current statin use as well as metabolic and kidney diseases are incorporated into the new calculation, while race has been removed from it, reflecting a growing awareness that race is a social construct.

Using PREVENT, the team found that among the study’s entire cohort, the 10-year risk of developing ASCVD was 4%, half as high as the risk calculated by the PCE (8%). The difference was even larger for Black adults (5.1% versus 10.9%) and for adults between the ages of 70 and 75 (10.2% versus 22.8%).

An estimated 4.1 million patients who are currently taking statins would no longer be recommended to take them based on PREVENT. For these patients and their physicians, clear and careful communication is key, said Anderson. “We don’t want people to think they were treated incorrectly in the past. They were treated with the best data we had when the PCE was introduced back in 2013. The data have changed.”

At the same time, it’s important to note that everyone’s risk will inevitably change over time, as well, he added. “For a patient who we now know is at lower risk than we previously thought, if we recommend they stop taking statins, they still could be back to a higher risk five years down the road, for the simple reason that everybody’s risk goes up as we get older.”

Reference: “Atherosclerotic Cardiovascular Disease Risk Estimates Using the Predicting Risk of Cardiovascular Disease Events Equations” by Timothy S. Anderson, Linnea M. Wilson and Jeremy B. Sussman, 10 June 2024, JAMA Internal Medicine . DOI: 10.1001/jamainternmed.2024.1302

Other authors on the study were Linnea Wilson, M.P.H., of Beth Israel Deaconess Medical Center, and Jeremy B. Sussman, M.D., M.P.H., of University of Michigan, Ann Arbor.

This research was supported by the National Institute on Aging (#K76AG074878).

Related Articles

Higher olive oil consumption linked with lower risk of dying from heart disease or cancer, walking is good, but moderate-vigorous exercise boosts fitness 3x more, new study provides reassuring data on myocarditis heart condition after mrna covid vaccination, new research finds eating lots of avocados has public health benefits for issues like obesity, the latest research on coffee and your risk for heart rhythm problems – good news, low-dose aspirin use for heart disease may reduce likelihood of covid-19 infection, popular energy drinks’ harmful effects on heart revealed in new research, vape flavorings are cardiotoxic and can damage the heart, covid-19’s impact on the heart – an in-depth look.

“…, while race has been removed from it, reflecting a growing awareness that race is a social construct.”

Statistics don’t support that naive, woke view. The social ideology behind such decisions may end up costing the lives of minorities who have a predisposition for certain diseases. Whether a particular race has predispositions for certain diseases is well established. What is less well understood is why the predispositions exist. However, be that as it may, pretending that race doesn’t correlate can be deadly because those susceptible may be less alert for symptoms. “The road to Hell is paved with good intentions.”

Everything about this study is useless. Read the article carefully and you will see all of the contradictions. When woke ideologies enter into medical research the results are corrupted .The fact is that statins are useless and dangerous. If you want to take a pill every day to lower cholesterol then take one of many natural supplements that have proven to work as well or better. Garlic and bergamot lowered my cholesterol significantly. The pharmaceutical companies have sponsored bogus studies to lie to the public about the facts. More corporate greed at the expense of our health.

Statins have been around for decades and the side effects, if any, are minimal. It is a proven fact that they are safe. I tend to trust my cardiologist more than conspiracy theories from social media. This article does not change anything for any sane person. Listen to your cardiologist.

If I’m 40 years old, I care about my 40 year risk, not my 10 year risk. Unless you are over 70, 10 year risk is extremely short sighted. My dad has always had marginally high LDL (between 100 and 130). Doctors never prescribed him statins because his 10 year risk was low. Now at age 74 he needs open heart surgery to clear plaques in the artery going to his heart. Meanwhile my mom had LDL above 250 in her 40s and was prescribed statins for decades keeping her LDL around 70-80 and her heart is perfectly fine.

If race is just a social construct, why is it hereditary?

Save my name, email, and website in this browser for the next time I comment.

Type above and press Enter to search. Press Esc to cancel.

• See us on facebook
• See us on twitter
• See us on youtube
• See us on linkedin
• See us on instagram

Researchers solve mystery of how statins improve blood vessel health

Statins designed to lower cholesterol have long been noted to work in mysterious ways to improve other aspects of cardiovascular health. A Stanford Medicine-led study uncovers how they do it.

May 8, 2023 - By Nina Bai

Researchers at Stanford Medicine and their colleagues have discovered how statins improve cardiovascular health beyond lowering cholesterol.  roger ashford/Shutterstock.com

Using new genetic tools to study statins in human cells and mice, Stanford Medicine researchers and collaborators have uncovered how the cholesterol-lowering drugs protect the cells that line blood vessels. 

The findings provide new insight into statins’ curiously wide-ranging benefits, for conditions ranging from arteriosclerosis to diabetes, that have long been observed in the clinic.

“The study gives us an understanding, at a very deep mechanistic level, of why statins have such a positive effect outside of reducing LDL,” said professor of medicine Joseph Wu , MD, PhD, referring to low-density lipoprotein, or “bad” cholesterol. “Given how many people take statins, I think the implications are pretty profound.”

Statins are the most prescribed medications in the country, with more than 40 million Americans taking them. Developed in the 1980s from compounds found in mold and fungi, statins target an enzyme that regulates cholesterol production in the liver. But clinical trials have shown that they also seem to safeguard against cardiovascular disease beyond their ability to lower cholesterol.

Heart failure patients who take statins, for example, are less likely to suffer a second heart attack. They have also been shown to prevent the clogging of arteries, reduce inflammation and even lower cancer risk. Yet these underlying mechanisms are poorly understood.

“Statins were invented to lower cholesterol by targeting the liver. But we didn’t know the targets or the pathways in the cardiovascular system,” said  Chun Liu , PhD, an instructor at the  Stanford Cardiovascular Institute  and co-lead author of the  study  published May 8 in  Nature Cardiovascular Research .  Mengcheng Shen , PhD, and Wilson Tan, PhD, postdoctoral scholars at the Stanford Cardiovascular Institute, are the other co-lead authors, and Wu is the senior author.

Hints from a dish

To take a closer look at statins’ effect on blood vessels, Liu and colleagues tested a common statin, simvastatin, on lab-grown human endothelial cells derived from induced pluripotent stem cells. Endothelial cells make up the lining of blood vessels, but in many diseases they transform into a different cell type, known as mesenchymal cells, which are poor substitutes.

“Mesenchymal cells are less functional and make tissues stiffer so they cannot relax or contract correctly,” Liu said.

The researchers suspected that statins could reduce this harmful transition. Indeed, endothelial cells treated with simvastatin in a dish formed more capillary-like tubes, a sign of their enhanced ability to grow into new blood vessels.

RNA sequencing of the treated cells offered few clues. The researchers saw some changes in gene expression, but they “didn’t find anything interesting,” Liu said.

It was not until they employed a newer technique called ATAC-seq that the role of statins became apparent. ATAC-seq reveals what happens at the epigenetic level, meaning the changes to gene expression that do not involve changes to the genetic sequence.

They found that the changes in gene expression stemmed from the way strings of DNA are packaged inside the cell nucleus. DNA exists in our cells not as loose strands but as a series of tight spools around proteins, together known as chromatin. Whether particular DNA sequences are exposed or hidden in these spools determines how much they are expressed.

“When we adopted the ATAC-seq technology, we were quite surprised to find a really robust epigenetic change of the chromatin,” Liu said.

ATAC-seq revealed that simvastatin-treated cells had closed chromatin structures that reduced the expression of genes that cause the endothelial-to-mesenchymal transition. Working backward, the researchers found that simvastatin prevents a protein known as YAP from entering the nucleus and opening chromatin.

The YAP protein is known to play important roles in development, such as regulating the size of our organs, but also has been implicated in the abnormal cell growth seen in cancer.

A look at diabetes

To see the drug in context, the researchers tested simvastatin on diabetic mice. Diabetes causes subtle changes to blood vessels that mimic the damage commonly seen in people who are prescribed statins — older patients who do not have a cardiovascular condition, Liu said. 

They found that after eight weeks on simvastatin, the diabetic mice had significantly improved vascular function, with arteries that more easily relaxed and contracted.

“If we can understand the mechanism, we can fine-tune this drug to be more specific to rescuing vascular function,” Liu said.

The findings also provide a more detailed picture of the vascular disease process, which could help doctors identify and treat early signs of vascular damage.

“I’ve been taking statins for the past 10 years to keep my cholesterol down. I also knew it has good vascular effects. I just didn’t know how it does it,” said Wu, the Simon H. Stertzer, MD, Professor who is also the director of the Stanford Cardiovascular Institute. “This study explains how.”

Researchers from the University of North Texas and the Ohio State University College of Medicine contributed to this study.

The study was supported by funding from the National Institutes of Health (grants R01 HL130020, R01 HL150693, R01 HL163680, R01 HL145676, P01 HL141084, R01 HL141371, R01 HL126527, R01 HL15864, R01 HL161002, R01 HL155282 and 18CDA34110293), an American Heart Association SFRN grant, an AHA Career Development Award and the Tobacco-Related Disease Research Program.

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu .

The majestic cell

How the smallest units of life determine our health

Masks Strongly Recommended but Not Required in Maryland, Starting Immediately

Due to the downward trend in respiratory viruses in Maryland, masking is no longer required but remains strongly recommended in Johns Hopkins Medicine clinical locations in Maryland. Read more .

• Vaccines  
• Masking Guidelines
• Visitor Guidelines  

Study Suggests ‘Remnant Cholesterol’ As Stand-alone Risk for Heart Attack and Stroke

.@HopkinsMedicine researchers suggest “remnant #cholesterol” could become sole predictor of #HeartAttack, #Stroke risk beyond #LDL, AKA “bad cholesterol.” @rquispe183 @hopkinsheart #EuropeanHeartJournal ›

An analysis of data gathered from more than 17,000 adults by Johns Hopkins Medicine researchers supports the belief that so-called “remnant cholesterol” (RC) provides an accurate stand-alone metric — just as doctors currently use measures of low-density lipoprotein (LDL) — for predicting risk of clogged arteries, heart attacks and strokes. In fact, the researchers say, an RC measure may detect the potential for disease when LDL levels do not.

Remnant cholesterol represents the amount of cholesterol in remnant lipoproteins, a form of very low-density lipoproteins (VLDL) from which sugary fatty acids — called triglycerides — have been removed. Along with traditional measurements of blood LDL cholesterol (frequently called “bad cholesterol”) levels, the cholesterol within remnant lipoproteins has been studied as an additional means of assessing a person’s risk for developing cardiovascular disease and stroke.

Remnant cholesterol levels are basically calculated as the total cholesterol amount minus the LDL and high-density lipoprotein cholesterol (HDL, the so-called “good cholesterol”) counts.

In their study, first published July 19, 2021, in the European Heart Journal , the researchers suggest that for people with relatively low levels of LDL cholesterol, a measured RC level greater than 24 micrograms per deciliter (24 millionths of a gram in a little more than a quart) of blood have a 40–50% higher risk for major heart disease or stroke.

“For decades, the thought was that people with low LDL cholesterol levels and relatively high levels of HDL cholesterol [the so-called “good cholesterol”] were at low risk for major heart disease,” says study lead author Renato Quispe, M.D., M.H.S. , a cardiovascular disease clinical and research fellow at the Johns Hopkins University School of Medicine. “But over time, studies kept suggesting that remnant cholesterol was a predictor of heart disease, independent of LDL cholesterol levels.”

To better assess the purported link between remnant cholesterol and disease risk, the Johns Hopkins Medicine team pooled information on 17,532 adults, obtained from three U.S. research databases. The data were from men and women between the ages of 30 and 68, who had no history of atherosclerotic cardiovascular disease (buildup of fatty plaque inside arteries) when they were originally studied. Data included cholesterol levels and other important cardiovascular risk factors, as well as which people developed major heart disease or stroke after recruitment to one of the databases.

The new study found that almost one of five individuals with levels of RC at or greater than 24 micrograms per deciliter experienced major heart disease or stroke within the following 18 years. Interestingly, say the researchers, this proportion was similar to those who had relatively low LDL cholesterol.

After accounting for non-cholesterol-related heart disease risk factors — such as tobacco use, high blood pressure, diabetes, advanced age and race (Blacks are at higher risk) — the researchers found a steady link between higher than normal RC and major heart disease.

Another important finding, the researchers claim, is that individuals with higher levels of RC also had more obesity and diabetes, and almost everyone had high triglyceride levels.

“We’re not saying LDL cholesterol is a poor measure of cardiovascular disease risk,” Quispe notes. “Instead, our analysis suggests that LDL should remain an important assessment tool; however, clinicians also should look at remnant cholesterol because it indicates a significant amount of risk on its own.”

Quispe emphasizes that calculating remnant cholesterol can be done easily with data available from a standard lipid panel — a test commonly given to patients by their doctors.

The U.S. Centers for Disease Control and Prevention estimates that 38 percent of the American adult population has high levels of total cholesterol, and one in four shows high levels of triglycerides. One-third of all deaths in this country are attributed to heart disease, stroke and other cardiovascular disease.

Quispe says future studies are likely to increase attention to remnant cholesterol measures and encourage clinical trials of drugs and lifestyle changes designed to reduce the risk of the diseases for which they provide warning.

Quispe is available for interviews.

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• RESEARCH BRIEFINGS
• 09 December 2021

Major cholesterol study reveals benefits of examining diverse populations

This is a summary of Graham, S. E. et al. The power of genetic diversity in genome-wide association studies of lipids. Nature https://doi.org/10.1038/s41586-021-04064-3 (2021) .

Access options

Access Nature and 54 other Nature Portfolio journals

Get Nature+, our best-value online-access subscription

24,99 € / 30 days

cancel any time

Subscribe to this journal

Receive 51 print issues and online access

185,98 € per year

only 3,65 € per issue

Rent or buy this article

Prices vary by article type

Prices may be subject to local taxes which are calculated during checkout

doi: https://doi.org/10.1038/d41586-021-02998-2

‘Expert opinion’ is published under a CC BY 4.0 licence.

Martin, A. R. et al. Nature Genet. 51 , 584–591 (2019).

Article   PubMed   Google Scholar  

Clarke, S. L., Assimes, T. L. & Tcheandjieu, C. Circ. Genom. Precis. Med . https://doi.org/10.1161/circgen.121.003178 (2021).

Article   Google Scholar  

Mahajan, A. et al. Preprint at medRxiv https://doi.org/10.1101/2020.09.22.20198937 (2020).

Klarin, D. et al. Nature Genet. 50 , 1514–1523 (2018).

Visseren, F. L. J. et al. Eur. Heart J. 42 , 3227–3337 (2021).

Download references

Reprints and permissions

Related Articles

• Medical research

African scientists must not be priced out of mental-health research

World View 03 SEP 24

The heart is put at risk of rupture by cells bordering damaged tissue

News & Views 28 AUG 24

Embryonic genome instability upon DNA replication timing program emergence

Article 28 AUG 24

How a trove of cancer genomes could improve kids’ leukaemia treatment

News 14 AUG 24

Origin and evolution of the bread wheat D genome

Article 14 AUG 24

People who lack the immune protein TNF can still fight infection

Fate induction in CD8 CAR T cells through asymmetric cell division

Faculty Positions & Postdocs at Institute of Physics (IOP), Chinese Academy of Sciences

IOP is the leading research institute in China in condensed matter physics and related fields. Through the steadfast efforts of generations of scie...

Beijing, China

Institute of Physics (IOP), Chinese Academy of Sciences (CAS)

FACULTY POSITION IN THE MOLECULAR BIOLOGY OF REPRODUCTION

Dallas, Texas (US)

The University of Texas Southwestern Medical Center (UT Southwestern Medical Center)

FACULTY RECRUITING IN GENE REGULATION

Permanent researcher positions for materials science.

NIMS (Tsukuba, Japan) invites international applications from researchers who can conduct research in materials science.

Tsukuba, Ibaraki (JP)

National Institute for Materials Science (NIMS)

Osaka University Immunology Frontier Research Center Postdoctoral Researcher

IFReC, Osaka University in Japan offers Advanced Postdoc Positions for Immunology, Cell Biology, Bioinformatics and Bioimaging.

Suita Campus, Osaka University in Osaka, Japan

Immunology Frontier Research Center, Osaka University

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

• Skip to main content
• Keyboard shortcuts for audio player

Your Health

• Treatments & Tests
• Health Inc.
• Public Health

Statins vs. supplements: New study finds one is 'vastly superior' to cut cholesterol

Allison Aubrey

Millions of Americans are prescribed statins to reduce the risk of heart disease, but many prefer to take supplements like fish oil, garlic and flaxseed. Peter Dazeley/Getty Images hide caption

Millions of Americans are prescribed statins to reduce the risk of heart disease, but many prefer to take supplements like fish oil, garlic and flaxseed.

If you were prescribed medicine to lower your risk of a heart attack or stroke, would you take it?

Millions of Americans are prescribed statins such as Lipitor, Crestor or generic formulations to lower their cholesterol. But lots of people are hesitant to start the medication.

Some people fret over potential side effects such as leg cramps, which may be — or may not be — linked to the drug. As an alternative, dietary supplements, often marketed to promote heart health, including fish oil and other omega-3 supplements (omega-3s are essential fatty acids found in fish and flaxseed), are growing in popularity .

So, which is most effective? Researchers at the Cleveland Clinic set out to answer this question by comparing statins to supplements in a clinical trial. They tracked the outcomes of 190 adults, ages 40 to 75. Some participants were given a 5 mg daily dose of rosuvastatin, a statin that is sold under the brand name Crestor for 28 days. Others were given supplements, including fish oil, cinnamon, garlic, turmeric, plant sterols or red yeast rice for the same period.

Choose the best diet for you

The maker of Crestor, Astra Zeneca sponsored the study, but the researchers worked independently to design the study and run the statistical analysis.

"What we found was that rosuvastatin lowered LDL cholesterol by almost 38% and that was vastly superior to placebo and any of the six supplements studied in the trial," study author Luke Laffin, M.D. of the Cleveland Clinic's Heart, Vascular & Thoracic Institute told NPR. He says this level of reduction is enough to lower the risk of heart attacks and strokes. The findings are published in the Journal of the American College of Cardiology .

"Oftentimes these supplements are marketed as 'natural ways' to lower your cholesterol," says Laffin. But he says none of the dietary supplements demonstrated any significant decrease in LDL cholesterol compared with a placebo. LDL cholesterol is considered the 'bad cholesterol' because it can contribute to plaque build-up in the artery walls – which can narrow the arteries, and set the stage for heart attacks and strokes.

"Clearly, statins do what they're intended to do," the study's senior author Steve Nissen, a cardiologist and chief academic officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic told NPR. By comparison, he says this research shows that supplements are not effective. "They do not promote heart health. They do not improve levels of the bad cholesterol."

Nissen says supplements can be expensive compared to statin medications. Depending on insurance, he says people may pay less than $5 a month out-of-pocket for rosuvastatin.

Shots - Health News

Cholesterol provides a clue about heart risks from sleep apnea.

"Statins are the most effective heart attack and stroke prevention drugs that we have really ever seen," says Michael Honigberg , a cardiologist and researcher at Massachusetts General Hospital who is not affiliated with the new study. He says the new findings add to an already large body of evidence showing statins lower LDL cholesterol, and he's not surprised to see that the supplements were not as effective.

However, he says, not everyone with a family history of heart disease or slightly elevated cholesterol should be on a statin. The American College of Cardiology and American Heart Association developed some prescription guidelines. Typically, if a person's LDL cholesterol (bad cholesterol) is 190 or higher, they're often advised to start a statin. Health care professionals use a risk calculator to estimate a person's risk of having a heart attack or stroke over the next 10 years. If the risk is high enough, based on factors including age, blood pressure and smoking status, then a statin may be recommended.

Honigberg says for people who have slightly elevated cholesterol, but are not at high enough risk to be prescribed a statin, he recommends that they focus on diet and exercise, rather than buying supplements. "I tell my patients to save their money and instead spend that money on eating heart healthy, high quality food."

He points to studies that show heart-healthy diets, including Mediterranean diets which emphasize healthy fats, lots of fruits, vegetables and whole grains and the DASH diet , significantly reduce the risk of heart disease. "I think a formulation that we perhaps don't use enough is that food is medicine and is probably a more effective medicine than supplements," says Honigberg.

The National Center for Complementary and Integrative Health, part of the National Institutes of Health, has also concluded, based on prior research, that omega-3 supplements do not reduce the risk of heart disease , but eating fish – which contains omega-3 fatty acids – is linked to a reduced risk. This suggests that omega-3 fatty acids are most beneficial as part of a healthy diet.

And it's worth noting that the NIH review concludes that omega-3 supplements may help relieve symptoms of rheumatoid arthritis. Omega-3s are also added to baby formulas to promote brain development. The NIH review also concludes that omega-3 supplements can lower triglycerides, a type of fat found in the blood. But Honigberg says this may be recommended for a "small subset of patients" with very high triglyceride levels.

As for people whose risk of heart disease is high enough to warrant a statin prescription, Honigberg says he spends a fair amount of time talking through concerns with patients.

"We talk about the excellent safety profile and the very, very low risk of side effects," he says. He describes the risk of serious side effects as "vanishingly small."

Sometimes patients stop taking a statin because they believe it's causing a certain side effect. But Honigberg points to a double-blind research study that showed when patients were given a placebo in place of a statin, patients reported feeling most of the same side effects.

"So the punch line of the trial is people blame statins for side effects the statins aren't really causing," he says.

• supplements
• heart disease

• Health A to Z
• Alternative Medicine
• Blood Disorders
• Bone and Joint
• Cardiovascular Diseases
• Child Health
• Coronavirus
• Dental Care
• Digestive System
• Disabilities
• Drug Center
• Ear, Nose, and Throat
• Environmental Health
• Exercise And Fitness
• First Aid and Emergencies
• General Health
• Health Technology
• Hearing Loss
• Hypertension
• Infectious Disease
• LGBTQ Health
• Liver Health
• Men's Health
• Mental Health
• Pain Management
• Public Health
• Pulmonology
• Senior Health
• Sexual Health
• Skin Health
• Women's Health
• News For Medical Professionals
• Our Products
• Consumer News
• Physician's Briefing
• HealthDay TV
• Wellness Library
• HealthDay Living
• Conference Coverage
• Custom Products
• Health Writing
• Health Editing
• Video Production
• Medical Review

New Blood Test Could Predict Women's 30-year Risk for Heart Disease

Key Takeaways

A blood test for cholesterol and inflammation can help predict a person’s long-range risk of heart disease

Women with the highest levels of three blood markers had a more than threefold increased risk of heart disease

They also had a 1.5-times increased risk of stroke

MONDAY, Sept. 2, 2024 (HealthDay News) -- Could a simple blood test help predict a woman’s three-decade risk of heart disease ?

Yes, claims new research that found women with high levels of three specific blood markers had a greater than threefold increased risk for heart disease within 30 years, compared to women with the lowest levels.

High levels of the three markers is also linked to a 1.5-times increased risk of stroke, researchers reported Aug. 31 in the New England Journal of Medicine . The findings were simultaneously presented at the European Society of Cardiology’s annual meeting in London.

“We can’t treat what we don’t measure, and we hope these findings move the field closer to identifying even earlier ways to detect and prevent heart disease,” said researcher Dr. Paul Ridker , director of the Brigham and Women’s Hospital Center for Cardiovascular Disease Prevention in Boston.

For the study, researchers analyzed blood samples and medical data from nearly 28,000 U.S. women, average age 55, who participated in a long-range health study starting between 1992 and 1995.

During a 30-year follow-up period, more than 3,600 of the women had a heart attack or stroke, needed surgery to reopen clogged arteries or suffered a heart-related death.

The research team checked the women’s blood samples for levels of two types of fat – “bad” LDL cholesterol and lipoprotein(a), a lipid partly made of LDL.

The samples were also tested for C-reactive protein, which is released by the liver in response to inflammation. High levels of CRP can indicate a serious health condition that causes inflammation, according to the National Institutes of Health.

Results showed that women with the highest levels of LDL cholesterol had a 36% increased risk for heart disease. The highest levels of lipoprotein(a) brought a 33% higher risk, and high CRP levels were linked to a 70% increased risk.

All three levels taken together formed the best assessment of a woman’s heart risk, researchers found.

Although the study was conducted using data from women, the researchers would expect to find similar results in men.

“In recent years, we’ve learned more about how increased levels of inflammation can interact with lipids to compound cardiovascular disease risks,” said researcher Dr. Ahmed Hasan , a medical officer and program director at the National Heart, Lung, and Blood Institute (NHLBI). “This helps explain why lower levels are often better.”

Immune cells can sense an accumulation of high cholesterol in cells or become activated in response to artery-clogging cholesterol plaques, sending out inflammatory signals, researchers explained in a NHLBI news release.

This increased inflammation can cause more plaques to form, or existing plaques to grow larger or even rupture, researchers said. Heart attacks, strokes and heart disease all are linked to arterial plaques.

People with high levels of these three blood markers can reduce their heart risk by getting regular exercise, eating a healthy diet, managing their stress and avoiding tobacco, researchers said.

There also are medications available to help manage cholesterol levels and reduce inflammation.

And the sooner the better -- steps people take earlier in life to protect their heart can add up over time, researchers said.

More information

The American Heart Association has more about preventing heart attacks .

SOURCE: National Heart, Lung, and Blood Institute, news release, Aug. 31, 2024

What This Means For You

People concerned about their heart health should talk to their doctor about their blood markers related to cholesterol and inflammation.

Related Stories

• Free In-Person Regional Events Focused on Oncology and Population Health

• Conferences

Lipid-Lowering Therapies Beyond Statins: ESC 2024

Research at the European Society of Cardiology Congress 2024 evaluated lipid-lowering therapy beyond statins alone in patients with high levels of low-density lipoprotein cholesterol.

For patients who cannot reach guideline-recommended low-density lipoprotein cholesterol levels on statins alone or who are statin intolerant, additional lipid-lowering therapies are needed.

Image credit: Pana Studio - stock.adobe.com

While statins are commonly prescribed to lower low-density lipoprotein (LDL) cholesterol, and they can have other benefits for the heart, blood vessels, and other organs, not all patients can reach guideline-recommended LDL cholesterol goals while other patients may be intolerant to statins. Research at the European Society of Cardiology Congress 2024 evaluated lipid-lowering therapy in addition to statins.

Bempedoic Acid for MACE Reduction

A systematic review of randomized controlled trials comparing bempedoic acid with placebo in patients with hyperlipidemia found the intervention significantly reduced 3-point major adverse cardiovascular events (MACE) consisting of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. 1 However, this reduction was largely driven by a lower rate of nonfatal myocardial infarction.

Bempedoic acid was first approved in the US in February 2020 as bempedoic acid and ezetimibe (Nexlizet) to lower LDL cholesterol in adults with heterozygous familial hypercholesterolemia or established atherosclerotic cardiovascular disease. 2 It was the first nonstatin agent approved in the US. Earlier this year, its label was expanded to not only include both primary and secondary prevention patients for lowering LDL cholesterol but also to reduce cardiovascular risk. 3

The researchers conducted a systematic search of PubMed, Web of Science, and Embase for published research until March 20, 2023. They identified 10 papers, with 18,200 (9765 on bempedoic acid and 8435 on placebo) patients included. While bempedoic acid significantly reduced MACE compared with placebo (OR, 0.84; 95% CI, 0.76-0.96; P < .001; I 2 = 0%), it did not have a significant effect on stroke (OR, 0.86; 95% CI, 0.69-1.08; P = .20; I 2 = 0%) or all-cause mortality (OR, 1.19; 95% CI, 0.73-1.93; P = .49; I 2 = 18%).

Lipid Lowering Beyond Statins

Other research analyzed the findings of 15 randomized controlled trials to evaluate how well ezetimibe, bempedoic acid, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors reduced LDL cholesterol in addition to statins. 4 Because a minority of patients on statin therapy reach suggested LDL thresholds, additional medications are added on to intensify therapy.

The researchers conducted a meta-analysis of IMPROVE-IT, FOURIER, ODYSSEY Outcomes, ODYSSEY LONG TERM, EWTOPIA 75, PACMAN-AMI, RACING, SPIRE I, SPIRE II, OSLER-1, OSLER-2, CLEAR HARMONY, CLEAR OUTCOMES, CLEAR SERENITY, and CLEAR WISDOM.

They found ezetimibe and PCSK9 inhibitors were associated with:

• 19% risk reduction in cardiovascular events (OR, 0.81; 95% CI, 0.75-0.86)
• 19% risk reduction in myocardial infarction (OR, 0.81; 95% CI, 0.74-0.89)
• 23% risk reduction in ischemic stroke (OR, 0.77; 95% CI, 0.70-0.84)

Similarly, this research found all-cause mortality was not improved by intensified lipid-lowering therapy, even when comparing follow-up of less than 3 years with 3 years or more.

“Intensified LDL-lowering therapy with ezetimibe, bempedoic [acid,] or PCSK-9 inhibitors, in addition to statins, reduces the risk of myocardial infarction and stroke, however, does not impact overall mortality,” the researchers concluded.

Lipid Lowering in High-Risk Patients

Finally, researchers from the United Kingdom analyzed lipid management in high-risk patients and found that real-world practice had not been updated to reflect changes in lipid guidelines, which advocate for the use of combination lipid-lowering therapy to achieve very low LDL cholesterol. 5

The study included 102 very high-risk patients with a prior history of acute coronary syndrome (ACS) or stroke who had a subsequent ACS or stroke between January 2022 and December 2022. The patients had been treated at a United Kingdom district general hospital.

Prior to admission, 15% of the patients had been on no lipid-lowering therapy. A total of 77.4% of patients had received a lipid profile in the 18 months prior to admission and only 19.6% were compliant with the standard secondary prevention guidelines of receiving high-intensity statins. A significant number of the patients still received no lipid profile in the 12 months after admission (21% in the ACS group and 57% in the stroke group).

Only 5 patients were escalated to receive high-intensity statin plus ezetimibe and 1 patient escalated to receive a statin plus ezetimibe plus a PSCK9 inhibitor. Only 45% of patients reached the guideline target of LDL less than 1.8 mmol/L in 1 year of follow up.

“A majority of our ACS patients did not have a lipid profile blood test during their admission highlighting the fact that whilst guidelines have progressed significantly over the last few years the clinical importance of lipid optimisation in practice has not been appreciated by many of the clinicians,” they wrote.

1. Mutschlechner D, Tscharre M, Huber K, Gremmel T. Cardiovascular events in patients treated with bempedoic acid vs. placebo: systematic review and meta-analysis. Presented at: ESC 2024; August 30, 2024; London, England.

2. New tablets for lowering cholesterol granted FDA approval. Pharmacy Times ® . February 27, 2020. Accessed August 29, 2024. https://www.pharmacytimes.com/view/new-combination-tablet-for-lowering-cholesterol-granted-fda-approval

3. Gallagher A. FDA expands label for bempedoic acid to reduce cardiovascular risk, with or without statins. Pharmacy Times . March 22, 2024. Accessed August 29, 2024. https://www.pharmacytimes.com/view/fda-expands-label-for-bempedoic-acid-to-reduce-cardiovascular-risk

4. Dykun I, Khoury M, Rassaf T, Mahabadi AA. Efficacy of lipid lowering therapy beyond statins to prevent cardiovascular events. Presented at: ESC 2024; August 30, 2024; London, England.

5. Ghazanfar A, Campbell R, Randall R, Child N. The difference between guideline based lipid optimisation and real-world practice in a very high risk population. Presented at: ESC 2024; August 30, 2024; London, England.

Cost in Cardiovascular Care: ESC 2024

Building Trust, Breaking Barriers: Health Care Leaders Tackle Primary Care Challenges

Tackling Obesity for Heart Health: A Global Weight Crisis

Insurance Insights: Dr Jason Shafrin Estimates DMD Insurance Value

Traditional Screening May Overlook Patients at Risk of Acute Coronary Syndrome

Environmental Risks Escalate Cardiovascular Disease Burden, Experts Warn

2 Commerce Drive Suite 100 Cranbury, NJ 08512

© 2024 MJH Life Sciences ® and AJMC® . All rights reserved.

The Latest Cholesterol Treatment Breakthroughs

Learn what’s new in research for managing this condition, including medications currently under study.

High cholesterol increases the risk of heart disease, the leading cause of death in the United States, and stroke (the fifth most-common cause), according to the Centers for Disease Control and Prevention (CDC). So it’s no wonder that medical researchers have dedicated a great deal of energy to finding new and improved treatment options. We spoke to the experts to get their take on the most exciting breakthroughs in cholesterol treatment research, from historic drug developments to medications that may be just around the corner.

Statins: The Go-To Drug Treatment for Cholesterol

The first treatment for high cholesterol is typically a prescription for a healthy diet, weight loss, and exercise, says Randy Zusman, M.D., cardiologist and director of the division of hypertension at the Massachusetts General Hospital Heart Center in Boston, MA. But medications can play an important role in treatment as well—especially when lifestyle changes simply aren’t cutting it. The medication doctors typically suggest first? Statins, says Dr. Zusman.

When they were introduced in the 1980s, statins changed the cholesterol-treatment game forever. In fact, at high-intensity doses, statins can reduce LDL (aka “bad”) cholesterol by 50% or more, according to the American College of Cardiology. They prevent cholesterol from forming in the liver and can lower triglycerides as well as raise HDL cholesterol (the “good” kind of cholesterol).

“Statins have proven highly effective at reducing heart attack and stroke ,” Dr. Zusman says. Since the ‘80s, a multitude of low-cost options have hit the market. In some cases, people with high cholesterol may benefit from taking another medication in combination with their statin for even greater benefit.

To this day, statins are still the first-line medication for the treatment of high cholesterol, but new med options are on the horizon—good news for those who are unable to tolerate statins due to side effects like muscle aches, says Dr. Zusman. Let’s take a look at what else your doctor might suggest.

Inclisiran: The Newest Approach

Another class of drugs already available to treat high cholesterol are injectable medications called PCSK9 inhibitors. The two drugs for this are alirocumab and evolocumab . A third promising drug currently under study that targets PCSK9 is Inclisiran, says Dr. Zusman. It works a bit differently from the PCSK9 inhibitors.

Inclisiran was only recently approved for use in Europe, explains James Underberg, M.D, lipid specialist at the Center for the Prevention of Cardiovascular Diseases at NYU Langone Health in New York City, and it’s expected to be approved in the United States soon.

Sign up for our weekly Heart Health Newsletter.

“Like some of the coronavirus vaccines, Inclisiran is an RNA-based product that effectively disrupts the pathways that lead to cholesterol production and ultimately elevate cholesterol levels,” Dr. Zusman explains. “We already know from data that it’s effective at reducing cholesterol levels, but we’re awaiting data about whether it protects against heart attack and stroke.”

Another big plus of this drug? It may only need to be taken once or twice a year to provide significant benefits, Dr. Underberg says.

Bempedoic Acid: Statin-like Results Without the Side Effects?

Bempedoic acid is a new drug for cholesterol treatment that was approved in 2020, per the U.S. Food and Drug Association (FDA). It works in a similar fashion to statins, explains Dr. Underberg. However, there are a few key differences—mainly that it’s not as effective as statins at lowering cholesterol. The trade-off comes when you look at side effects.

“One of the common side effects of statins—which you see in about 5% to 10% of people who take them—are muscle aches,” Dr. Underberg explains. “One reason we think that happens is statins act both in the liver and the muscle, where bempedoic acid only acts in the liver, so it may benefit people who can't take statins from that muscular perspective.” Bempedoic acid is taken orally, which some people may prefer over the injectable PCSK9 inhibitors, Dr. Underberg adds.

Unlike PCSK9 inhibitors, Dr. Underberg says that bempedoic acid hasn’t yet been shown to reduce heart attack and stroke risk in a clinical trial—but another trial is in progress. And it’s kind of a big deal.

“This is the first trial with heart disease ever done since statins came out where the drug was not studied on top of a statin,” Dr. Underberg explains. “This drug is being studied in patients who can’t take statins, so we’ll know the effect of it, independent from statins. This is intriguing because all the other drugs—like ezetimibe and PCSK9 inhibitors—are indicated to be used on top of statins.”

Pure EPA Fish Oil

It sounds basic, but it’s true: Plain old fish oil is the next exciting breakthrough that may benefit more people with heart disease. Recent studies are showing that a certain type of fish oil could help lower fats in the blood—namely high triglycerides, which when combined with high “bad” cholesterol or low “good” cholesterol, raise the risk of heart disease.

“Until recently, there were many drugs that lowered triglycerides, but many of them were not cardioprotective,” explains Dr. Zusman. Enter, highly purified eicosapentaenoic (EPA) acid, a fish oil that’s shown to lower triglycerides in patients with a history of diabetes and cardiovascular disease. A 2019 study in the New England Journal of Medicine found that taking 4 grams of pure EPA fish oil on top of a statin could significantly lower the risk of such cardiovascular events. Worth noting: The fish oil we’re talking about—pure EPA fish oil—isn’t sold over the counter. (The kind of oil you find in a store isn’t regulated by the FDA.)

“The over-the-counter fish oil products that our patients use extensively are not pure products but have other things that actually interfere with the beneficial effects of the purified products,” explains Dr. Zusman.

Currently, pure EPA fish oil is only available as a prescription medication called Vascepa (icosapent), which was FDA-approved in 2019 to help reduce the risk of cardiovascular events like heart attack .

New Targets for Cholesterol Drugs

Some research is focusing on finding new targets within the body that could aid in lowering cholesterol. For example, another burgeoning development has to do with lipoprotein(a), a sub-type of LDL cholesterol.

“Elevated levels of lipoprotein(a) are an underrecognized risk factor for people who have risk of heart disease,” explains Dr. Underberg.

So far, there aren’t any drugs approved to specifically target lipoprotein(a)—but that may soon change, as two new drugs are on the horizon that lower lipoprotein(a) using messenger RNA. It will take several years before we have data from the studies on these drugs—but it’s promising news.

Cholesterol Treatment Future Is Bright

The experts agree: It’s a hopeful era for cholesterol treatment research, and there are more options than ever for managing high cholesterol and reducing the risk of heart disease—from medications to lifestyle changes.

“It’s an exciting time to be taking care of people with cholesterol disorders because there’s a lot we can do with medications,” says Dr. Underberg. “But remember: The biggest impact we can make still is getting people to stop smoking, exercise, eat heart-healthy diets, and reduce stress.”

High Cholesterol Facts: Centers for Disease Control and Prevention. (2020.) “High Cholesterol Facts.” cdc.gov/cholesterol/facts.htm

Bempedoic Acid Information: American College of Cardiology. (2019.) “Bempedoic Acid, the Next LDL Cholesterol-Lowering Medication to Join the Arsenal? Insights From the CLEAR Wisdom Trial.” acc.org/latest-in-cardiology/articles/2019/05/03/10/20/bempedoic-acid-the-next-ldl-cholesterol-lowering-medication-to-join-the-arsenal

Bempedoic Acid FDA Approval: American College of Cardiology. (2020.) “FDA Approves Bempedoic Acid for Treatment of Adults With HeFH or Established ASCVD.” acc.org/latest-in-cardiology/articles/2020/02/24/10/09/fda-approves-bempedoic-acid-for-treatment-of-adults-with-hefh-or-established-ascvd

EPA Fish Oil Study: New England Journal of Medicine . (2019.) “Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia.” nejm.org/doi/full/10.1056/NEJMoa1812792

EPA Fish Oil FDA Approval: U.S. Food and Drug Administration. (2019). “FDA approves use of drug to reduce risk of cardiovascular events in certain adult patient groups.” fda.gov/news-events/press-announcements/fda-approves-use-drug-reduce-risk-cardiovascular-events-certain-adult-patient-groups

Lipoprotein(a) Information: American College of Cardiology. (2019.) “Lipoprotein(a): The Next Promising CVD Risk Assessment Tool and Prevention Target Among the High-Risk Population.” acc.org/latest-in-cardiology/articles/2019/09/17/15/02/lipoprotein-a

• Share via facebook
• Share via pinterest
• Share via twitter
• Share via mail

More Like This

Can alcohol raise your cholesterol levels.

What’s Tripping Up Your Cholesterol Treatment?

What to Know About Small Dense LDL Cholesterol

Does Testosterone Affect Cholesterol Levels?

An official website of the United States government

Here’s how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( A locked padlock ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

• Heart-Healthy Living
• High Blood Pressure
• Sickle Cell Disease
• Sleep Apnea
• Information & Resources on COVID-19
• The Heart Truth®
• Learn More Breathe Better®
• Blood Diseases & Disorders Education Program
• Publications and Resources
• Clinical Trials
• Blood Disorders and Blood Safety
• Sleep Science and Sleep Disorders
• Lung Diseases
• Health Disparities and Inequities
• Heart and Vascular Diseases
• Precision Medicine Activities
• Obesity, Nutrition, and Physical Activity
• Population and Epidemiology Studies
• Women’s Health
• Research Topics
• All Science A-Z
• Grants and Training Home
• Policies and Guidelines
• Funding Opportunities and Contacts
• Training and Career Development
• Email Alerts
• NHLBI in the Press
• Research Features
• Ask a Scientist
• Past Events
• Upcoming Events
• Mission and Strategic Vision
• Divisions, Offices and Centers
• Advisory Committees
• Budget and Legislative Information
• Jobs and Working at the NHLBI
• Contact and FAQs
• NIH Sleep Research Plan
• < Back To Home

Single blood test predicts 30-year cardiovascular disease risks for women

Measuring inflammation and lipids in midlife may support earlier detection, treatment 

Research supported by the National Institutes of Health has found that measuring two types of fat in the bloodstream along with C-reactive protein (CRP), a marker of inflammation, can predict a woman’s risk for cardiovascular disease decades later. These findings, presented as late-breaking research at the European Society of Cardiology Congress 2024, were published in the New England Journal of Medicine .

“We can’t treat what we don’t measure, and we hope these findings move the field closer to identifying even earlier ways to detect and prevent heart disease,” said Paul M. Ridker, M.D., M.P.H., a study author and the director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital, Boston.

For the study, investigators collected blood samples and medical information from 27,939 healthcare providers living in the United States who participated in the Women’s Health Study . Women, who started the study between 1992-1995 at an average age of 55, were followed for 30 years. During this period, 3,662 study participants experienced a heart attack, stroke, surgery to restore circulation, or a cardiovascular-related death. Researchers assessed how high-sensitivity CRP, along with low-density lipoprotein (LDL) cholesterol and lipoprotein(a) , or Lp(a), a lipid partly made of LDL, singularly and collectively predicted these events.

Participants were grouped into five categories — ranging from those with the highest to lowest levels — to measure each of the three markers. Researchers found that women with the highest levels of LDL cholesterol had a 36% increased associated risk for heart disease compared to those with the lowest levels. Those with the highest levels of Lp(a) had a 33% increased associated risk, and those with the highest levels of CRP had a 70% increased associated risk.

When all three measures — LDL cholesterol, Lp(a), and CRP — were assessed together, participants with the highest levels had more than a 1.5-times increased associated risk for stroke and more than a 3-times increased associated risk for coronary heart disease compared to women with the lowest levels.  

The researchers note that while only women were assessed in this study, they would expect to find similar results in men.

“In recent years, we’ve learned more about how increased levels of inflammation can interact with lipids to compound cardiovascular disease risks,” said Ahmed A.K. Hasan, M.D., Ph.D., a medical officer and program director at the National Heart, Lung, and Blood Institute (NHLBI). “This helps explain why lower levels are often better.”

Immune cells, which help the body repair itself from wounds or infection, can also sense the accumulation of extra cholesterol in cells or become activated in response to the build-up of plaque and send out inflammatory signals. This creates a hyperinflammatory environment where plaque can form, become larger, or even rupture — and cause cardiovascular events.

To support optimal cardiovascular health, the researchers emphasize primary prevention . This includes getting regular physical activity, eating a heart-healthful diet, managing stress, and avoiding tobacco or quitting smoking. Other measures for people with increased risks may include using medication to lower cholesterol and/or reduce inflammation. Researchers have also found that steps people take earlier in life to support their heart and vascular health can add up over time and correlate with better health outcomes years and even decades later.

LDL cholesterol, which is routinely measured by healthcare providers, can be treated with widely-available therapies, such as statins. However, standard Lp(a) and CRP screening recommendations can vary.

Some countries recommend screening for Lp(a) since elevated levels are often due to inherited risks. In areas without universal Lp(a) screenings, like the U.S., physicians can order tests for people with heart disease or who have a family history of it. Some therapies are available for those with elevated levels and researchers are testing new approaches to personalize and improve treatment options.  Testing for CRP also varies. Screening often depends on a person’s underlying risks or is up to the discretion of the provider. Colchicine, an anti-inflammatory therapy previously used for gout, was approved by the Food and Drug Administration in 2023 to offset risks for cardiovascular disease among people with atherosclerosis. Additional anti-inflammatory therapies and approaches are being studied.  This research was supported by grants from NHLBI ( HL043851 , HL080467 , and HL099355 ) and the National Cancer Institute ( CA047988 , CA182913 ).

Study: Ridker PM, Moorthy V, Cook NR, et al. Inflammation, Cholesterol, Lipoprotein(a), and 30-Year Cardiovascular Outcomes in Women. N Engl J Med. 2024; doi: 10.1056/NEJMoa2405182.   

About the National Heart, Lung, and Blood Institute (NHLBI):  NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives. For more information, visit  www.nhlbi.nih.gov .

About the National Institutes of Health (NIH):  NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit  www.nih.gov .

More Information

Related health topics, health education, related news.

Simple blood test could predict a person’s heart disease risk 30 years out, study finds

A new approach to a routine blood test could predict a person’s 30-year risk of heart disease, research published Saturday in the New England Journal of Medicine found. 

Doctors have long assessed their patients’ risk for cardiovascular disease by using a blood test to look at cholesterol levels, focusing particularly on LDL or “bad” cholesterol . But limiting blood testing to just cholesterol misses important — and usually silent — risk factors, experts say.

“We have other biomarkers that tell us about other kinds of biological problems our patients who are destined to have cardiovascular disease are likely to have,” said lead study author Dr. Paul Ridker, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in Boston.

Ridker and his team found that in addition to LDL cholesterol, two other markers — a type of fat in the blood called lipoprotein (a), or Lp(a), and an indicator of inflammation — are important predictors of a person's risk of heart attack , stroke and coronary heart disease. 

The findings were also presented Saturday at the European Society of Cardiology Congress 2024 in London.

In the study, the researchers analyzed data from nearly 30,000 U.S. women who were part of the Women’s Health Study . On average, the women were 55 years old when they enrolled in the years 1992 through 1995. About 13% — roughly 3,600 participants — had either a heart attack or stroke, had surgery to fix a narrowed or blocked artery, or died from heart disease over the 30-year follow-up period. 

Though the research was done in women, Ridker said the findings would likely also apply to men.

Still, the focus on women was on purpose, he said. “This is a largely preventable disease, but women tend to be under treated and underdiagnosed.” 

All of the women had blood tests done at the beginning of the study to measure their LDL cholesterol, Lp(a) and C-reactive protein levels, a marker of inflammation in the body.

These measurements, individually as well as together, appeared to predict a woman’s heart health over the next three decades, the study found.

Women with the highest levels of LDL cholesterol had a 36% higher risk for heart disease compared with those with the lowest levels. The highest levels of Lp(a) indicated a 33% elevated risk, and those with the highest levels of CRP were 70% more at risk for heart disease. 

When the three were looked at together, women who had the highest levels were 1.5 times more likely to have a stroke and over three times more likely to develop coronary heart disease over the next 30 years compared with women with the lowest levels.  

All of the markers have been individually linked to higher risk of heart disease, but “all three represent different biological processes. They tell us why someone is actually at risk,” Ridker said.

Intervening early 

Traditional risk factors for heart disease include obesity, diabetes, high blood pressure and high cholesterol levels . Testing for Lp(a) and CRP can reveal less obvious risk factors.

“You can have no traditional risk factors and just by having that high Lp(a), you are at higher risk,” said Dr. Rachel Bond, system director of women’s heart health at Dignity Health in Arizona, who was not involved with the study. 

Bond said everyone should get their Lp(a) tested once in their lives. If they have elevated levels at any point, they will for life. There is one caveat: Post-menopausal women can develop high Lp(a) and may want to have their levels tested again at that time, Bond said. 

On the other hand, LDL cholesterol and CRP levels fluctuate throughout a person’s life. Ridker supports doctors running the three-pronged blood test when patients are in their 30s or 40s, to catch potentially overlooked risk factors early, when there is time to intervene. 

Although exercising, eating well and not smoking are all important, people with already elevated levels of Lp(a), LDL and CRP will likely require medication, said Dr. Steven Nissen, chief academic officer of the Heart, Vascular and Thoracic Institute at the Cleveland Clinic, who was not involved with the study. 

“We can’t expect lifestyle interventions are going to do the job alone for most people,” Nissen said. 

The study had several limitations that future research may address, including a lack of racial and ethnic diversity, which plays an important role in a person’s risk for heart disease. Nearly all of the participants — 94% — were white.

Nissen also noted that the study stopped measuring Lp(a) levels once they passed a certain threshold.

“The highest levels of lipoprotein (a) in this study weren’t even high enough to reach the clinical threshold at which a patient would be treated,” he said. “It tends to underestimate the risk of lipoprotein (a).”

Dr. Kunihiro Matsushita, a professor of epidemiology at Johns Hopkins Bloomberg School of Public Health, who specializes in cardiology, said that while inflammation is definitely important, “that doesn’t mean CRP is the best marker for predicting cardiovascular disease risk.” 

“Using three biomarkers is interesting, but the choice of which biomarkers these are can be explored further,” said Matsushita, who also wasn't involved with the new research. 

He added that testing for inflammation, LDL and Lp(a) is particularly important for people who are traditionally thought of as low risk for heart disease, including women, young people and those of East Asian descent. 

Ridker agreed.

“Physicians will not treat things they don’t measure,” he said. 

Kaitlin Sullivan is a contributor for NBCNews.com who has worked with NBC News Investigations. She reports on health, science and the environment and is a graduate of the Craig Newmark Graduate School of Journalism at City University of New York.

• Store finder

Research reveals hidden dangers of high saturated fat diet

Category: Research

A diet high in saturated fat is more dangerous for the heart than a diet high in unsaturated fat, even when there has been no weight gain, according to new research funded by us and presented at the European Society of Cardiology Congress 2024 in London.

The study found concerning changes to regularly measured invisible markers of heart health in people who ate a high saturated fat diet and didn’t see a change their body weight. People on this diet had a roughly 20 per cent rise in fat in their liver and around 10 per cent higher blood cholesterol levels after just 24 days, compared to before they started the diet.

Nikola Srnic, MD/DPhil Candidate at the University of Oxford, who led the research said:

“We want to study how the type of fat that a person eats affects their risk of heart and circulatory disease beyond a change in body weight. The results suggest that a diet high in saturated fat may negatively change cardiovascular disease risk factors even when a person does not gain weight.

“On the other hand, we saw protective effects if a person ate a diet high in polyunsaturated fat. Although our study is ongoing, our findings so far suggest that even when you are not gaining weight, different fats can have drastically different effects on our health in a short time frame.”

Heightened risks

Saturated fats are found in foods including butter, fatty meats, cakes, pastries and biscuits. Polyunsaturated fats, including omega-3 and omega-6, supply the body with essential nutrients and are found in foods including oily fish, like mackerel and salmon, sunflower oil, and some nuts.

During the study, 24 participants were asked to follow a diet high in either saturated fat or polyunsaturated fat for up to 24 days. Each participant had an MRI scan and blood test at the beginning and end of the study to assess the impact of the type of fat they consumed on known risk factors for heart and circulatory diseases.

Body weight was unchanged in both groups after 24 days, yet the participants who ate more saturated fat had test and scan results that are linked to an increased risk of heart disease. This group’s levels of total cholesterol and non-HDL cholesterol – known as ‘bad’ cholesterol – in the blood were approximately 10 per cent higher than before the study.

The saturated fat group also saw a roughly 20 per cent increase in the amount of fat stored in their livers. Too much fat being stored in the liver heightens the risk of person developing type 2 diabetes and cardiovascular diseases.

Protective role for some fats

The group which ate a diet high in polyunsaturated fat saw very different changes after 24 days. They experienced a drop in total blood cholesterol and ‘bad’ cholesterol levels of around 10 per cent, and an increase in energy reserves in their heart muscle, compared to before the study.

The effects seen in this group underline the protective role that some fats can play, reinforcing the benefits of including polyunsaturated fats as part of a balanced diet.

The researchers also assessed the mechanisms in heart muscle cells that may help to explain these observations. They grew these cells in conditions enriched with saturated or polyunsaturated fats and measured how the cells responded.

If cells were grown in conditions with more polyunsaturated fat, they became more active in taking up fat and breaking it down for energy. This could be one way in which a diet high in polyunsaturated fat could help the body lower the level of fats in the blood.

Professor James Leiper, our Associate Medical Director, said:

“Saturated fat has long been understood to cause a much higher risk of heart and circulatory disease. This study adds to this consensus and gives us evidence that saturated fat may silently start to pose a risk to heart health very quickly, without causing any changes to a person’s weight.

“The results the researchers saw in lab-grown heart cells will hopefully improve our understanding of how these changes happen. Longer studies with more participants are needed to confirm these findings and show whether these short-term changes increase people’s risk of serious heart problems in the long term.”

Find out more about fats

News archive

• 9 things we learnt at the UK's largest heart conference
• AI detects life-threatening blood vessel inflammation from Covid-19 variants
• A new system for GP data
• BHF's Chief Executive among top 10 CEOs in the UK
• BHF NI calls for mandatory CPR training in post-primary schools
• Covid-19 and Cardiovascular Health: Reflections and the Future
• Critical six-week window to reset blood pressure after giving birth
• Drugs to stabilise plaques could prevent stroke
• Drug used to reduce blood sugar levels in diabetic patients could also benefit hearts
• Government confirms plans to press ahead with junk food advert restrictions
• Research finds heart cell changes in people with dilated cardiomyopathy
• How my heart condition affected my mental health
• Injectable microspheres to repair failing hearts
• Invisible insulin resistance linked to increased risk of sudden death
• The BHF joins forces with international research funders to improve global heart health
• Iron deficiency anaemia in early pregnancy increases risk of congenital heart disease
• Mac Twins announced as new BHF ambassadors
• BHF appeals for volunteers looking to develop skills and try something new
• New risk calculator to help save many more lives from heart attack and stroke
• Our response to Christian Eriksen’s confirmed cardiac arrest
• Philip Yea appointed as our second Distinguished Fellow
• Nearly a quarter of a million people waiting for heart procedures and surgery
• Research identifies new ways to try and prevent lethal blood clots
• Scientists discover possible explanation for mysterious Takotsubo syndrome
• Simple blood test could detect life-threatening aortic tears
• Could your smart watch alert you to risk of sudden death?
• Smokefree England an ‘achievable’ ambition, says BHF following new report
• Time is running out for soft opt-out organ donation in NI
• Vinnie Jones teams up with BHF on campaign to urge people to learn CPR
• Weight gain and diabetes threaten progress in reducing heart attacks and strokes

Related Links

• Risk factors