Adults with elevated levels of three biomarkers for heart disease—lipoprotein(a), remnant cholesterol, and high-sensitivity C-reactive protein (hsCRP)—had nearly triple the risk of heart attack compared to those without elevated levels, according to a preliminary study to be presented at the American Heart Association’s Scientific Sessions 2025, Nov. 7-10, in New Orleans.
The analysis, which used data from the UK Biobank for over 300,000 participants free of heart disease at enrollment, found that those with elevated levels of only one biomarker had a 45% increased risk, while those with two elevated biomarkers had double the risk. The three tests measure different pathways to cardiovascular disease: genetics (Lp(a)), cholesterol metabolism (remnant cholesterol), and inflammation (hsCRP).
“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,” said lead researcher Richard Kazibwe, M.D., M.S., assistant professor of internal medicine at Wake Forest University School of Medicine. “These biomarkers work together like pieces of a puzzle. One piece cannot show the full picture, yet when combined, we can see a much clearer and more complete depiction of heart attack risks.”
Participants were followed for a median of 15 years, during which 10,824 (3.5%) had a heart attack. The study defined elevated levels as being in the highest 20% of values for each biomarker. The findings suggest that evaluating combined results could help health care professionals act more quickly and provide tailored care for high-risk individuals.
Although these tests are not yet routine, Lp(a) and hsCRP tests are available at most labs upon request, and remnant cholesterol can be calculated from standard cholesterol panels. “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,” Kazibwe said.
The 2025 AHA/ACC High Blood Pressure Guideline recommends using the PREVENT™ risk calculator, developed by the American Heart Association in 2023, to assess cardiovascular disease risk. Pamela Morris, M.D., FAHA, an American Heart Association volunteer expert, noted that “this study supports recommendations that consideration of risk enhancers including Lp(a), hsCRP and remnant cholesterol can play an important role in personalizing risk estimates.”
The research has limitations, including its observational nature and predominantly white participant pool (95% from the UK Biobank). Further studies are needed to confirm results in diverse populations and to determine whether using these tests to guide treatment improves outcomes. The findings are considered preliminary until published in a peer-reviewed journal.
For more information on heart disease risk, visit the American Heart Association’s Understand Your Risks to Prevent a Heart Attack page. The abstract is available in the Scientific Sessions 2025 Online Program Planner.
