A comprehensive analysis of three blood tests may significantly enhance the prediction of heart attack risk, potentially allowing for earlier identification of high-risk individuals. This finding emerges from a preliminary study set to be presented at the American Heart Association’s Scientific Sessions 2025, taking place from November 7-10, 2025, in New Orleans, Louisiana. The research focuses on three biomarkers associated with cardiovascular disease: lipoprotein(a) (Lp(a)), remnant cholesterol, and high-sensitivity C-reactive protein (hsCRP).
In the study, adults demonstrating elevated levels of all three biomarkers exhibited nearly three times the risk of experiencing a heart attack compared to participants with normal levels. Each of these blood tests evaluates distinct pathways contributing to cardiovascular disease. Lp(a) is an inherited type of cholesterol that can lead to arterial plaque buildup. Remnant cholesterol reflects harmful fatty particles that standard cholesterol tests often overlook, while hsCRP measures inflammation in the body, signaling potential stress and arterial damage.
According to the lead researcher, Richard Kazibwe, M.D., M.S., an assistant professor of internal medicine at Wake Forest University School of Medicine in Winston-Salem, North Carolina, “Each of the blood tests on its own indicates 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.” He further explained that “these biomarkers work together like pieces of a puzzle,” creating a clearer and more comprehensive picture of heart attack risks.
Study Details and Implications
Researchers analyzed health data from the UK Biobank, one of the world’s largest health databases, which included over 306,000 participants initially free of heart disease. The participants were followed for a median of 15 years, during which 10,824 (3.5%) experienced a heart attack. The study revealed a clear pattern: individuals with all three biomarkers in the top 20% had nearly triple the risk of a heart attack. Those with two elevated results faced more than double the risk, while participants with one elevated test result had a 45% higher risk.
Kazibwe emphasized that assessing the combined results of these blood tests could enable healthcare professionals to act more swiftly, facilitating tailored care for those at the highest risk. This approach may involve advocating for lifestyle changes or initiating treatments, such as medications to lower cholesterol and blood pressure, which are vital for reducing heart attack risk.
Although these blood tests are not yet included in routine screening guidelines, Kazibwe suggests that this combination approach is more accessible than it might seem. Lp(a) and hsCRP tests are available at most laboratories, and healthcare professionals can calculate remnant cholesterol using standard cholesterol panels obtained during routine checkups.
Kazibwe noted, “Even if traditional risk factors like cholesterol and blood pressure are under control, these simple blood tests can identify hidden inflammation, genetic risk, and cholesterol abnormalities,” allowing for earlier detection of heart disease risk.
Future Directions in Cardiovascular Care
The study aligns with the 2025 AHA/ACC High Blood Pressure Guideline, which recommends that healthcare professionals utilize the Predicting Risk of Cardiovascular Disease Events (PREVENTTM) equation. Developed by the American Heart Association in 2023, this risk calculator considers cardiovascular, kidney, and metabolic health factors to provide a more precise estimate of an individual’s cardiovascular disease risk.
Pamela Morris, M.D., FAHA, an American Heart Association volunteer expert and a professor of cardiology, highlighted the importance of considering these biomarkers in clinical decision-making. “Advances in the accuracy and precision of risk for atherosclerotic cardiovascular disease mean that clinicians can now more precisely identify individuals who are likely to benefit from preventive therapies,” she stated.
Morris, who was not involved in the study, added that the findings underscore the necessity of considering risk enhancers like Lp(a), hsCRP, and remnant cholesterol in personalizing treatment plans.
Kazibwe acknowledged that some healthcare professionals may hesitate to adopt additional tests due to concerns about costs and insurance coverage. However, the growing body of research supporting these tests, combined with new treatment options, is making them increasingly relevant in preventive cardiology.
He concluded, “The three biomarker tests represent part of a larger toolkit for assessing heart attack risks, which also includes genetic risk scores and coronary artery calcium scans.” The challenge moving forward will be learning how to integrate this data effectively to aid healthcare professionals in making personalized decisions for each patient.
While the research has limitations, including its observational nature and the demographic homogeneity of the UK Biobank participants, it sets the stage for further studies. Future research will be necessary to determine if employing these tests to guide treatment decisions leads to better patient outcomes, particularly in diverse populations across the globe.
