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Blood test predicts 30-year risk of heart attack, stroke and cardiovascular death in women

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A new study has found that a blood test measuring three independent biological markers can better predict risk of major cardiovascular events over the next three decades than measuring only one.

In a landmark study of 27,939 initially healthy American women, a single measure of high-sensitivity C-reactive protein (hsCRP, a marker of vascular inflammation), low density lipoprotein cholesterol (LDL-C or “bad cholesterol”), and lipoprotein(a) (Lp(a), a genetically determined lipid fraction), strongly predicted cardiovascular risk over an unprecedented 30-year follow-up period.

“Doctors cannot treat what they don’t measure,” said lead author Paul Ridker, MD, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital, who presented the findings at ESC Congress 2024.

“To provide the best care for our patients, we need universal screening for inflammation, cholesterol, and lipoprotein(a), and we need it now. By so doing, we can target our treatments to the specific biologic need of individual patients, fulfilling our longstanding hope to provide truly personalised preventive care.”

The research team analyzed data from the Women’s Health Study (WHS), funded by the U.S. National Institutes of Health (NIH) through research grants to preventive cardiology investigators in the Division of Preventive Medicine at the Brigham. The landmark trial began in 1993 and has followed female health professionals aged 45 years and older ever since.

Women had their hsCRP, LDL-C and Lp(a) levels tested in a blood sample obtained when they enrolled in the WHS. The primary endpoint of the study was a first major adverse cardiovascular event—heart attack, coronary revascularization, stroke, or death from cardiovascular causes.

A wake-up call for women

To assess each marker as well as the combined effect of having elevated levels of two or all three, the research team divided participants into five quintiles, ranging from those with the highest to the lowest levels of the markers. Researchers found that, compared to women with the lowest levels of individual markers:

  • Women with the highest levels of hsCRP had a 70 per cent greater risk of a major cardiovascular event;
  • Women with the highest levels of LDL-C had a 36 per cent greater risk;
  • Women with the highest levels of Lp(a) had a 33 per cent greater risk.

While hsCRP was the strongest of the three biomarkers, all mattered greatly. Women who had elevated levels of all three markers were 2.6 times more likely to have a major adverse cardiovascular event. This association was even stronger for stroke—women with the most elevated levels were 3.7 times more likely to have a stroke over the next 30 years.

“These data should be a wake-up call for women,” said co-author Julie Buring, ScD, principal investigator of the WHS and an epidemiologist in the Brigham’s Division of Preventive Medicine.

“Waiting until women are in their 60s and 70s to initiate heart attack and stroke prevention is a prescription for failure.”

Reducing risk

Each of the three risk factors is modifiable with a combination of lifestyle changes and drug therapy. Multiple randomized trials have demonstrated that lowering cholesterol and lowering inflammation both significantly reduce risks of heart attack and stroke. Further, several new drugs that markedly reduce Lp(a) as well as second-generation anti-inflammatory agents are being tested to see if they too can lower rates of clinical events.

The new data strongly support earlier and more aggressive use of targeted preventive interventions, particularly among women for whom cardiovascular disease remains underdiagnosed and undertreated.

“While we still need to focus on lifestyle essentials like diet, exercise, and smoking cessation, the future of prevention is clearly going to include combination therapies that target inflammation and Lp(a) in addition to cholesterol,” said Ridker.

The study has been published simultaneously in the New England Journal of Medicine.

Insight

AI-driven digital tool delivers sustained blood pressure reductions, study finds

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A large real-world study has found that an AI-powered digital tool developed by Megi Health can significantly reduce blood pressure over time while maintaining high long-term patient engagement –  a combination that has remained a major challenge in hypertension care.

The peer-reviewed research, published in JMIR mHealth and uHealth, analysed real-world data from more than 5,000 adults using Megi’s digital blood pressure management platform as part of their everyday lives.

The results showed meaningful reductions in systolic blood pressure, with the greatest improvements seen in people who started with higher readings.

Crucially, the study found that outcomes improved the longer people stayed engaged with the platform.

Dr Petroula Laiou, chief scientific officer at Megi and senior author of the study, said: “High blood pressure can’t be managed through occasional GP visits alone.

“This study shows that ongoing, easy-to-use digital support can help people control their blood pressure in the real world –  particularly those at highest risk.

“It also demonstrates how combining digital tools with routine clinical care creates a more effective ‘phygital’ model for managing long-term conditions.”

Around half of users were still active after one year, while patient feedback showed high satisfaction, greater confidence in self-managing blood pressure, and reduced anxiety around monitoring.

Rather than relying on a tightly controlled clinical trial, the study examined how people actually use digital health tools in real life.

Users interacted with Megi through WhatsApp, receiving reminders to measure their blood pressure and take medication, and entering readings directly into the chat.

This approach enabled continuous tracking of blood pressure, engagement and outcomes over time.

The research was led by a multidisciplinary team from King’s College London, King’s College Hospital NHS Foundation Trust, Megi Health, the Magdalena Clinic for Cardiovascular Diseases in Zagreb, and the University of Zagreb.

The cohort included both women and men aged 17 to 95, with more than 90 per cent of participants regularly submitting blood pressure readings.

The findings add to growing evidence that home-based digital monitoring can overcome many of the limitations of clinic-based blood pressure checks, which are often affected by white-coat or masked hypertension.

By combining regular home readings with behavioural support, digital tools such as Megi could play an increasingly important role in long-term cardiovascular care.

Dr Nina Šesto, CEO of Megi Health, said: “What’s striking is not just the blood pressure reductions, but how long people stayed engaged.

“That level of sustained use is exactly what hypertension care has been missing.

“As health systems move towards prevention, home monitoring and long-term condition management, this approach aligns closely with the direction set out in the NHS 10-Year Health Plan.”

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Ten FemTech innovations join UK Evaluate programme

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Ten FemTech innovations have been chosen for Accelerating FemTech: Evaluate, led by Health Innovation South London and DigitalHealth.London with UK partners.

The accelerator, part of the Innovate UK Biomedical Catalyst, supports women’s health solutions at technology readiness level 4 or higher, meaning prototypes proven in a lab or relevant setting and preparing for market entry.

Delivered with Health Innovation Yorkshire & Humber, the programme will help companies grow, connect with decision-makers and plan real-world testing in health services.

Women spend around 25 per cent more of their lives in ill health than men, yet only one per cent of global health research and innovation focuses on women-specific conditions.

Selected innovations include a heated bra for cyclical breast pain, cognitive behavioural therapy for menopause support, biosensors to help detect respiratory disease, compassionate support after pregnancy loss and an AI-powered thermal imaging tool for breast screening. Cognitive behavioural therapy is a talking therapy that helps people change unhelpful thoughts and behaviours. Thermal imaging maps heat patterns on the skin to highlight potential concerns. Biosensors are small devices that detect biological signals.

Dr Sean Clarkson, head of strategic operations at Health Innovation Yorkshire & Humber, said: “The ten selected innovations have huge potential to make an impact on women’s health. I am delighted to support the programme and excited to see how these innovative solutions develop.”

“At Yorkshire & Humber we have a strong focus on women’s health and we will be providing mentorship, subject matter expertise and business coaching.”

Several solutions draw on lived experience, including a microbiome serum inspired by recurrent urinary tract infections, and a maternity training platform that brings local women’s experiences to life through virtual reality.

The cohort also includes tools that support community-based care, such as a digital preventive maternal health platform, a therapeutic platform for people living with premenstrual dysphoric disorder and premenstrual syndrome, and an agency-building app for chronic pelvic pain.

Over three months, innovators will follow a hybrid curriculum with virtual training and in-person support from a business coach, plus guidance on evaluation routes such as health economic analyses.

Companies will also attend two residentials, take part in expert-led webinars, receive one-to-one mentoring across the health and care system and join an end-of-programme showcase, with the chance to apply for closed-call feasibility funding through Innovate UK’s Biomedical Catalyst.

Dr Chiara Board, chief executive and founder of P.Happi, said: “We need more innovation and access to better care in women’s health—and with limited funding flowing into the sector, programmes like this are so vital. We’re thrilled to have the opportunity to join the Accelerating FemTech: Evaluate programme alongside other changemakers. P.Happi, born from science and personal experience, will use this opportunity to advance our mission of making pioneering microbiome innovation accessible to more women through community and public healthcare.”

Anja Ueland, director of Meyva, said: “I’m really proud that Meyva has been selected for the Accelerating FemTech: Evaluate programme. This opportunity will help us build the evidence needed to support heat therapy as a safe, effective option for women experiencing cyclical mastalgia. For too long, breast pain has been dismissed or overlooked. It means a lot to see this issue recognised and to be part of a programme helping women’s health innovations move from personal experience to real-world impact.”

Geetha Manjunath, chief executive of Niramai Health Analytix, said: “We are honoured to be selected for the Accelerating FemTech: Evaluate programme. This recognition reinforces our mission to make advanced, accessible health screening available to women everywhere. Through this initiative, we look forward to collaborating with the UK’s vibrant health innovation ecosystem to expand Niramai’s clinically proven, AI-based Thermalytix technology, improve early breast cancer detection, and contribute to the NHS’s goals for equitable and preventive women’s health.”

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AI model predicts five-year breast cancer risk

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A new AI model can predict a person’s risk of developing breast cancer up to five years in advance by analysing mammograms.

The technology could make screening more effective by identifying women who need additional imaging.

In one study, women the algorithm flagged as high risk were four times more likely to develop breast cancer than those with a low AI score.

The Clairity Consortium, an international association of 46 research institutions in North and South America and Germany, developed the model, Clairity Breast, trained on more than 420,000 mammograms.

Christiane Kuhl, director of the department of diagnostic and interventional radiology at RWTH Aachen University Hospital, said: “With this newly-developed AI model, we can predict with much greater precision that a woman will develop breast cancer in the next five years, on the basis of mammograms that are normal and show no signs of breast cancer.”

Unlike traditional risk models, the AI does not need family history, genetics or lifestyle data. It calculates risk from mammograms alone and classifies women into risk categories.

The model assesses not only the amount of glandular tissue but also its texture and arrangement, another breast cancer risk factor.

Kuhl said current “one-size-fits-all” screening is outdated.

“The AI model can decide within seconds whether a woman needs an MRI for early detection or not,” she said.

MRI uses magnetic fields and radio waves to create detailed images but is more expensive than mammography.

Kuhl advocated a two-step approach: “First, mammography for early detection; then an AI analysis to determine the risk of disease over the next five years.”

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