A NEW study has revealed that stroke risk in healthy women is strongly associated with high levels of inflammation and blood lipids, suggesting that early screening for multiple biomarkers could improve long-term prevention.
Inflammation and Cholesterol in Stroke Prevention
The relationship between inflammation, blood fats and stroke risk has long been debated, particularly in women who are often underrepresented in cardiovascular research. Current prevention guidelines recommend checking LDL cholesterol levels from age 40, but testing for high-sensitivity C-reactive protein (hsCRP) and lipoprotein(a) remains inconsistent. This study, drawn from decades of follow-up in the Women’s Health Study, highlights how these markers, when elevated together, may sharply increase the likelihood of stroke, especially of the ischaemic type.
Methods and Long-Term Results on Stroke Risk
Researchers analysed data from 28 345 healthy women aged 45 years and older who provided blood samples between 1992 and 1995. None had cardiovascular disease or cancer at enrolment. Participants were followed for up to 30 years, during which 1 345 stroke events were recorded over a median of 27.7 years. Higher baseline hsCRP levels showed a strong trend with increased stroke incidence, rising from under 0.7 mg/L in the lowest quintile to at least 5.2 mg/L in the highest. Only women in the top LDL cholesterol (≥3.4 mmol/L) and lipoprotein(a) (≥44.1 mg/dL) quintiles had significantly higher cumulative stroke risk than those with the lowest readings. Adjusted hazard ratios for the highest versus lowest quintiles were 1.32 (95% CI 1.07–1.61) for total stroke and 1.56 (1.22–1.99) for ischaemic stroke with hsCRP, and 1.23 (1.04–1.45) and 1.27 (1.05–1.55) for lipoprotein(a). Women with all three biomarkers elevated faced a 60% higher total stroke risk and a 79% higher ischaemic stroke risk. None of the biomarkers were linked to haemorrhagic stroke.
Implications for Clinical Practice
These results underscore the value of combining inflammatory and lipid testing to improve early prevention of stroke. Regular assessment of hsCRP and lipoprotein(a) alongside LDL cholesterol may help identify women at higher long-term risk, allowing earlier intervention through lifestyle modification or medication. The findings call for more comprehensive screening guidelines that prioritise early detection to reduce stroke burden in women over the lifespan.
Reference
Nordestgaard AT et al. High-sensitivity C-reactive protein, LDL cholesterol, lipoprotein (a) and 30-year risk of stroke in healthy women: a prospective, longitudinal cohort study. The Lancet Neurology. 2025;24(11):920-30.
