A new study suggests that combining blood tests to measure three specific biomarkers can significantly enhance the ability to predict heart attack risks. This analysis, focusing on lipoprotein(a) (Lp(a)), remnant cholesterol, and high-sensitivity C-reactive protein (hsCRP), may enable healthcare professionals to identify individuals at high risk for cardiovascular disease earlier and tailor prevention strategies accordingly. The findings will be presented at the American Heart Association’s Scientific Sessions scheduled for November 7-10, 2025, in New Orleans.
The research indicates that adults with elevated levels of all three biomarkers face nearly three times the risk of experiencing a heart attack compared to those with normal levels. Each of these blood tests assesses different pathways leading to cardiovascular disease. Lipoprotein(a), a hereditary type of cholesterol, contributes to plaque buildup in arteries. Remnant cholesterol includes harmful fat particles that standard cholesterol tests often overlook, while hsCRP serves as a marker for inflammation in the body, potentially indicating stress that can damage arteries.
According to Richard Kazibwe, M.D., M.S., the lead researcher and an assistant professor at Wake Forest University School of Medicine, “Each blood test on its own shows only a modest increase in heart attack risk. However, when we found elevated levels for all three, the risk of heart attack was nearly three times higher.” Kazibwe further explained that these biomarkers collectively create a clearer picture of heart attack risks, much like pieces of a puzzle.
The study involved a comprehensive review of health data from the UK Biobank, which includes one of the largest health databases globally, tracking over 306,000 participants who were free of heart disease at enrollment. Over a median follow-up period of 15 years, researchers monitored heart attack occurrences, revealing a distinct pattern: participants with elevated results across all three tests had nearly triple the risk of heart attack. Those with two elevated results experienced more than double the risk, while individuals with one elevated result had about a 45% higher heart attack risk.
Kazibwe emphasized that this pattern underscores the importance of evaluating combined results from the three blood tests. Such evaluations could enable healthcare professionals to act swiftly, recommending lifestyle changes or initiating treatments like cholesterol- or blood pressure-lowering medications to mitigate risks.
Although these tests are not currently part of routine screening guidelines, Kazibwe believes that their combined approach might be more feasible than it appears. Tests for Lp(a) and hsCRP are widely available upon request, and healthcare professionals can derive remnant cholesterol from standard cholesterol panels often conducted during regular checkups. This cholesterol is calculated by subtracting LDL and HDL cholesterol from total cholesterol.
Kazibwe remarked, “Even if traditional risk factors like cholesterol and blood pressure are under control, these straightforward blood tests can uncover hidden inflammation, genetic risks, and cholesterol abnormalities. The results could help healthcare professionals detect heart disease risks earlier, guiding proactive measures before symptoms manifest or major cardiac events occur.”
The findings are particularly relevant given the 2025 AHA/ACC High Blood Pressure Guideline, which advocates using the Predicting Risk of cardiovascular disease EVENTs (PREVENTTM) equation to accurately assess cardiovascular risk and optimize prevention strategies. This risk calculator, developed by the American Heart Association in 2023, incorporates various health factors to provide personalized risk estimates, aiding treatment decisions for individuals.
While acknowledging that some healthcare professionals may hesitate to incorporate additional tests due to cost and insurance concerns, Kazibwe noted that ongoing research and emerging treatments are increasing the relevance of these tests in preventive cardiology. “These three biomarker tests represent a broader toolkit for assessing heart attack risks, which also includes genetic risk scores and coronary artery calcium scans,” he stated.
The study, while revealing valuable patterns, does have limitations. As an observational study, it cannot establish direct causation between elevated biomarker levels and heart attacks. Further research is necessary to determine whether utilizing these tests to inform treatment decisions can improve patient outcomes or save lives. Additionally, as the UK Biobank comprises approximately 95% white participants, more studies are needed to confirm the applicability of these findings across diverse populations in the U.S. and elsewhere.
In conclusion, the integration of these biomarkers into routine assessments may provide critical insights into cardiovascular health, allowing for earlier interventions and potentially reducing the incidence of heart attacks. As the field advances, healthcare providers may be better equipped to deliver personalized care tailored to each patient’s unique risk profile.
