These 3 blood tests could tell women their 10-year risk for heart disease

A study published in the New England Journal of Medicine indicates that a simple blood test can accurately predict the 30-year risk of cardiovascular disease in women. The test measures LDL cholesterol, LDL(a), and high-sensitivity C-reactive protein (CRP).

The study followed 27,939 women in the Women’s Health Study over a 30-year time period between 1992 and 1995. The average age at baseline was 54.7 years. The results indicated that women with the highest level of LDL cholesterol had a 36 percent increased risk for heart disease compared to women with the lowest levels. Those with the highest levels of LDL(a) had a 33 percent increased risk and those with the highest levels of CRP had a 70 percent increased risk of heart disease.

When all three measures were taken together, women with the highest levels had a 1.5 times increased risk of stroke and a three times increased risk of coronary heart disease compared to women with the lowest levels. Because of these results, the National Heart, Lung and Blood Institute recommends testing for all three. In September of 2025, the Journal of the American College of Cardiology also began recommending all three tests.

“It’s a great study,” said cardiologist Mary Callahan, DO, at Cardiovascular Associates of Sandwich. “The problem is that a lot of insurances won’t cover the recommended testing. They’ll cover a regular lipid panel, which has LDL in it, but they usually don’t cover LDL(a) or CRP, so people have to check with their insurance to see if they’re covered.”

Who Should Have the Tests

Since the blood tests can be so important, Dr. Callahan recommends that even if a patient’s insurance doesn’t cover the tests, certain people should consider paying out of pocket for the tests. Those patients include:

• People with a strong family history of coronary heart disease.
• People with diabetes.
• People who are overweight or obese.
• People who have high cholesterol indicated by the regular lipid panel.

Dr. Callahan uses an American College of Cardiology risk calculator to help patients determine their 10-year risk of stroke, heart attack or death from cardiovascular disease. The risk calculator asks for the patients’ age, race, blood pressure, total cholesterol, diabetes status, whether they are taking blood pressure medication, and whether they smoke. It then gives a risk factor percentage.

“Anyone with a risk of over 10 percent should have the test,” Dr. Callahan said. “They should have it at least once to see where it is. It’s not something that you would do multiple times a year. You do them once and then maybe again in a year.”

That advice is for the LDL(a) and CRP. For the regular lipid panel, if that number is high and the patient needs treatment with a statin, Dr. Callahan orders a follow-up blood test in three months to make sure the statin is working and that there is no damage to the patient’s liver.

High LDL(a) Treatment

Doctors are still trying to figure out the best medication for those with high LDL(a).

“The assumption has always been that if you lower the LDL, the LDL(a) will follow, but we’re not seeing that in all patients,” Dr. Callahan said. “I’ve been following these LDL(a) patients for almost a year now and there are some patients, men and women, where it does follow the LDL in that if the LDL is low the LDL(a) is low.”

But there is another group of patients who have low LDL levels, but high LDL(a), she added.

Some patients see success lowering LDL(a) with the cholesterol-lowering medication Zetia (ezetimibe).

The Mediterranean Diet is considered the gold standard for overall heart health, but Dr. Callahan advises patients with high blood pressure to follow the DASH diet, which is similar except it is more restrictive about sodium intake. Both diets emphasize eating plenty of fruits and vegetables, whole grains, lean protein and healthy fats like olive oil, avocados, nuts and seeds, while limiting saturated and trans fats.

“If you could do 20 to 30 minutes in a row of walking at a moderate pace at least three days a week, you’re going to get the cardiovascular benefit of exercise,” she said.