For decades, the villains of heart disease have been clear: high cholesterol, smoking, and elevated blood pressure. Millions of women dutifully manage these risks, believing they are in the clear. But a startling truth is emerging from one of the longest-running studies of women’s health, revealing a ghost in the machine—a silent threat that may explain why heart attacks and strokes can strike even the seemingly healthiest among us.
The culprit is chronic inflammation.
A groundbreaking analysis, drawing on three decades of data from over 12,000 women, has placed this invisible condition on equal footing with high LDL “bad” cholesterol as a primary driver of cardiovascular disease. The findings, presented Friday at the European Society of Cardiology Congress and published in the European Heart Journal, suggest a major blind spot in how American medicine assesses heart risk.
“Half of all heart attacks and strokes occur in people who do not have any major risk factors,” explained Dr. Paul Ridker, the study’s lead author and a preventive cardiologist at Mass General Brigham. His research shows that a woman’s risk can be dangerously high due to inflammation alone, even if her cholesterol and blood pressure are perfect.
A Gap in the Armor
Unlike cholesterol, inflammation isn’t something you can feel. It’s the body’s immune system stuck in a low-grade, constant state of alert. This simmering internal fire can damage blood vessels over time, creating the perfect environment for plaque to form and rupture. Yet, measuring it is not a standard part of cardiovascular screening in the United States.
Dr. Anais Hausvater, a cardiologist at NYU Langone Health who was not involved in the research, called the new study “potentially practice changing.” She points to a frustrating gap between knowledge and practice. “Despite a growing body of evidence that inflammation is an incredibly important cardiovascular risk factor… the vast majority of women are not being screened,” she said.
The solution is neither complex nor costly. A simple, inexpensive blood test for high-sensitivity C-reactive protein (hsCRP) can precisely measure these inflammation levels. In Europe, Dr. Ridker noted, checking hsCRP is already the standard of care.
The new study, which pulled from the extensive Women’s Health Study, focused on women with no standard modifiable risk factors. Over 30 years, nearly 1,000 of these “healthy” women suffered a heart attack or stroke. The common thread among them was a significantly higher level of hsCRP.
The Power of Knowing
The implications are profound. High inflammation can be effectively treated with statins, the same drugs used for cholesterol. But a woman with smoldering inflammation and a healthy cholesterol profile would never be prescribed one under current guidelines.
This is a missed opportunity for prevention. Dr. Ridker pointed to a previous clinical trial where women with high inflammation but no other risk factors saw their risk of a heart attack or stroke plummet by 38% after receiving statin therapy. Without the test, these women remain vulnerable.
“The bottom line is that physicians will not treat what they don’t measure,” Ridker stated plainly.
Experts believe this study should be a wake-up call. “This is a very exciting study,” said Dr. Tania Ruiz, a cardiologist at Vanderbilt University Medical Center. “It’s the first large-scale study of hsCRP as a predictor of cardiovascular events in otherwise healthy women.” She added that women with autoimmune conditions like lupus might be at higher risk for inflammation, but without a test, it’s impossible to know.
For now, the power lies with patients. Dr. Hausvater’s advice is direct: “This is another tool women should be offered to assess their risk. I would recommend that patients ask their physicians to check their hsCRP.”