US Pharm. 2021;46(2):43-44.
While deaths related to heart disease have declined among the elderly, studies suggest that death rates among younger patients have remained stagnant or increased slightly. To understand what factors put younger individuals at higher risk of premature coronary heart disease (CHD), researchers from Brigham and Women’s Hospital and the Mayo Clinic analyzed more than 50 risk factors in 28,024 women who participated in the decades-long Women’s Health Study. Notably, women younger than age 55 years with type 2 diabetes had a tenfold greater risk of having CHD over the next 2 decades, with lipoprotein insulin resistance (LPIR) proving to be a strong predictive biomarker as well. The findings were published in JAMA Cardiology.
“We’re going to see, unfortunately, younger and younger people having heart attacks,” said corresponding author Samia Mora, MD, MHS, of the Brigham’s Center for Lipid Metabolomics in the Division of Preventive Medicine and an associate professor at Harvard Medical School. “When a younger individual has a cardiovascular event, it will affect their quality of life going forward, their productivity, and their contribution to society.”
The researchers analyzed approximately 50 biomarkers associated with cardiovascular health. Commonly used metrics like LDL cholesterol (or “bad” cholesterol) and hemoglobin A1C (a measure of blood sugar levels) had much weaker associations with CHD onset in women younger than age 55 years than LPIR, a newer metric for insulin resistance. LPIR uses a weighted combination of six lipoprotein measures and is analyzed through specialized laboratory testing. Whereas LDL cholesterol was only associated with a 40% increase in risk of CHD onset in women younger than age 55 years, LPIR demonstrated a 600% increase.
“In otherwise healthy women, insulin resistance, type 2 diabetes, and its sister diagnosis, metabolic syndrome, were major contributors to premature coronary events,” said Dr. Mora. “Women under 55 who have obesity had about a fourfold increased risk for coronary events, as did women in that age group who smoked or had hypertension. Physical inactivity and family history are all part of the picture as well.”
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