62 million women in the United States currently have some form of cardiovascular disease. According to a 2026 scientific statement from the American Heart Association, that number is only going up. Add to that fact that cardiovascular disease in women builds over decades while standard screening tools look in the wrong direction, and it’s easy to understand why heart disease is the leading cause of death in women.
New research is changing that picture, though. Three biomarkers can predict 30-year cardiovascular risk with more accuracy than the tools most doctors use today. And for the first time, consumer-accessible technology, from a targeted blood panel to a wearable on your finger or wrist, gives us the ability to start measuring what actually matters.
🧠 The takeaway
Three biomarkers — LDL cholesterol, hsCRP, and Lp(a) — can predict a woman's cardiovascular risk across a 30-year horizon. Most women have never had all three measured.
Wearables are already measuring meaningful cardiovascular signals. Not diagnoses, but early pattern changes worth paying attention to.
The most meaningful window for cardiovascular intervention is a woman's 40s and 50s, decades before most screening even begins, but it’s never too late to start paying attention.
❤️🩹 Did you know women are less likely to get cholesterol drugs that prevent heart attacks? Here’s how to know if you’re being overlooked and what to ask your doctor.
The three numbers that predict 30-year risk
A landmark study published in the New England Journal of Medicine followed nearly 28,000 healthy American women for 30 years and found that a single midlife blood draw could predict long-term cardiovascular risk better than standard screening tools.
The three biomarkers that mattered were:
LDL cholesterol — familiar, but often under-treated in women
hsCRP (high-sensitivity C-reactive protein) — a marker of inflammation that may be even more central to women's cardiovascular risk
Lp(a) (lipoprotein(a)) — a heritable lipid particle that most women have never had measured
"Each one contributed independently. Knowing all three was significantly more predictive than knowing any one alone," says Leena Pradhan-Nabzdyk, PhD, MBA, Assistant Professor at Harvard Medical School.
Beyond those, ApoB also matters enormously, says Pradhan-Nabzdyk. Unlike LDL, which estimates the weight of harmful lipoproteins, ApoB counts the actual particles. The European Society of Cardiology now recommends it as the primary lipid metric while most U.S. physicians still aren't ordering it routinely.
💡 Doctors don't treat what they don't measure, and, unfortunately, patients may need to ask for these tests rather than waiting for a physician to initiate them.
A note on Lp(a)
Lp(a) is not included in a standard lipid panel, but it only needs to be measured once. Most women have never had it tested, and it's a number largely determined by genetics that doesn't change much with lifestyle. If your cardiovascular risk feels unclear to you, this is one of the first things worth asking your doctor about.
Have you ever had Lp(a) measured?
What your wearable is already measuring
Biomarker data from a blood panel is powerful, but it's a snapshot. A wearable gives you a continuous record of how your body is actually functioning day to day.
"A wearable can show the daily touchpoints of data. Most doctors, at best, get to examine their patients once a year," says Chris Curry, MD, Clinical Director for Women's Health at Oura. "The role of wearable data is usually not in making a diagnosis, but about describing someone's inner workings — their biology and physiology — in a way that can show if something is worrisome."
For women, Dr. Curry highlights three wearables metrics worth your attention:
1. Sleep quality and continuity
Midlife is where hormonal transition, stress, and fragmented sleep start to compound. Sleep disruption shows up in mood, recovery, cognition, and cardiovascular signals — sometimes before anything else does.
2. Cardiovascular age (pulse wave velocity)
Pulse wave velocity (PWV) is the speed at which your blood pulses or travels throughout your body after each heart beat, and serves as a proxy for arterial stiffness. Stiffer arteries are associated with increased risk for several cardiovascular diseases including heart disease, stroke, and heart failure. Plus, it can be a contributor to other illnesses, such as kidney disease and Alzheimer’s disease, says Curry. Our choices (diet, smoking, exercise) can worsen or improve PWV. A wearable can track how it changes when you make different choices about your day-to-day
3. Stress (both daily and cumulative)
Chronic stress shifts the body into sympathetic dominance, disrupting estrogen, testosterone, and thyroid signaling while increasing inflammation and insulin resistance. Wearables can now distinguish between acute daily stress and patterns that signal impending burnout. "Sometimes we present as calm on the outside, but our heart signals and stress levels tell a different story," says Curry. “The role I see is: a wearable detects change early, surfaces patterns clearly, and helps people and clinicians ask better questions sooner.”
The value of measurement
“Risk prediction and treatment plan should always go hand-in-hand,” says Pradhan-Nabzdyk. Through standard bloodwork women can access hsCRP, LDL, ApoB, Lp(a), fasting glucose, fasting insulin, and a full lipid panel including triglycerides. Direct-to-consumer lab services have brought most of this within reach even if your doctor won’t order it for you.
Once you have the information you need, your path forward will depend on which marker is elevated and by how much.
🥗 Elevated hsCRP means a lifestyle-first intervention usually
💊 Elevated LDL-C or ApoB calls for a direct conversation about lipid-lowering therapy
🤰🏻 For women with adverse pregnancy histories, the pregnancy history changes the risk calculus with more intense or earlier interventions recommended
“The key principle across all of this: specificity matters. “Eat better and exercise” is true, but insufficient as clinical guidelines. When you know which pathway is driving risk, you can target the intervention. That is the value of measuring,” says Pradhan-Nabzdyk.
For a motivated woman, a targeted blood panel plus a modern wearable gives her more meaningful data than most of what was available in a standard annual physical a decade ago, says Pradhan-Nabzdyk.
Potential questions to bring to your next appointment
✔ Have you checked my Lp(a)?
✔ Can I get hsCRP and ApoB alongside my lipid panel?
✔ Given my pregnancy history (preeclampsia, gestational diabetes, or hypertension) what does that mean for my cardiac risk?
✔ What is my perimenopause status doing to my cardiovascular risk right now?
✔ Am I on the right type and intensity of statin if one is indicated for me?
The bigger shift for a healthier future
We have historically screened women for cardiovascular risk in their 60s and 70s, after the damage is done. The data now tells us that the most meaningful window for intervention is in a woman's 40s and 50s, when markers are already building and lifestyle changes still have decades of compounding ahead of them. (But, it’s never too late to ask for these labs or to start tracking your data.)
Women are coming into this conversation better informed than they were even five years ago, Pradhan-Nabzdyk says. "They are tracking their own data. They are asking better questions. They are finding the research themselves. What they need is a clinical ecosystem that meets them there."
“The ideal future is not wearable versus clinic — it’s wearable data flowing into care pathways so continuous real-world signals and clinical evaluation can complement each other,” Curry adds. “Continuous data allows researchers to see the ‘in between,’ which is where a lot of women’s health actually unfolds.”
If those three things come together — better representation in the data, better longitudinal science, and better integration into care — then predictive health for women can move from reactive symptom management to earlier, more personalized support. That’s a future worth building towards.
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