An early one-time simultaneous measurement of LDL-C, high-sensitivity C-reactive protein (hsCRP) and lipoprotein(a) (Lp[a]) can independently predict long-term cardiovascular risk, according to a large prospective cohort study published April 1 in the European Heart Journal.

Using data from the European EPIC-Norfolk study, conducted between 1993 and 1997, researchers examined data from 17,087 initially healthy individuals (57% women). Baseline LDL-C, hsCRP and Lp(a) levels were measured once at study entry, and participants were followed for two decades for major adverse cardiovascular events (MACE) defined as hospitalization or death from coronary artery disease or ischemic stroke.

Results showed that over a median 20.5-year follow-up, a total of 3,249 first MACE occurred. Notably, the 20-year risk of MACE was predicted with increasing quintiles of baseline LDL-C, hsCRP and Lp(a) levels: the multivariable-adjusted hazard ratios for MACE for the highest vs. the lowest quintiles were 1.78, 1.55 and 1.19, respectively.

While higher quintiles of LDL-C, hsCRP and Lp(a) were each independently predictive of long-term cardiovascular risk in both women and men, researchers said "the highest risk was observed in participants with all three biomarkers elevated." Compared with individuals with no biomarker elevations, the multivariable-adjusted HR for participants in quintile 5 with three biomarkers was 2.41, with two biomarkers was 1.68 and 1.33 for one biomarker. Importantly, absolute risks were higher in men than women.

"The current findings highlight multiple opportunities for improving primary prevention," said Jordan M. Kraaijenhof, MD, et al. "As cardiovascular disease is a lifetime disorder where early prevention achieves the greatest gains, these data reinforce the value and clinical utility of early life detection of risks." They add that with the availability of commercial assays for hsCRP and LP(a) that are standardized, inexpensive and widely available, "we believe the time has come for universal screening of these three biomarkers in primary as well as secondary prevention."