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From The Desk Of Clarence Bass

"Cholesterol screening is currently the gold standard for predicting heart attack risk, but nearly half of all heart attacks occur among men and women with normal cholesterol levels," says cardiologist Paul Ridker. "In fact, the amount of risk associated with [low level inflammation] is almost twice that associated with high levels of low density cholesterol."

"In the past year or two, experts say, the evidence has become overwhelming that inflammation hidden deep in the body is a common trigger of heart attacks, even when clogging in the arteries is minimal." Associated Press, August, 2002

 

Inflammation More Important Predictor Than Cholesterol

I’ve been reading about inflammation as a measure of heart attack risk for some time. But I became more interested recently when Arnie Jensen, M.D., my physician at the Cooper Clinic, suggested that I have mine checked. That did it. I decided to look more deeply into the role of the inflammation in heart disease. As it turns out, mine is very low, barely detectable, which peaked my interest even more.

The idea that heart disease is simply a matter of cholesterol-clogged arteries doesn’t work any more, because half of all heart attacks occur in people with normal cholesterol levels. Something other than cholesterol must be at work. Inflammation seemed the most likely candidate to cardiologist Paul Ridker, an associate professor at Harvard Medical School and one of the world’s leading experts on arterial inflammation.

"Over the past 15 years, molecular biology has taught us that atherosclerosis – or hardening of the arteries – is very much an inflammatory disease...," Dr. Ridker told Nutrition Action Health Letter (September 2000). "... We don’t know exactly what injury triggers the inflammatory response, ... [but] it’s possible that atherosclerosis is nothing more than any inflammatory disease, just like arthritis."

To learn how to better assess risk, Ridker and his colleagues at Harvard Medical School took blood samples from 28,263 healthy, middle-aged women and compared 12 different markers, including C- reactive protein (an indicator of low-level inflammation), total cholesterol, low density cholesterol, and other compounds to determine which was the most accurate predictor of heart disease and stroke. High-sensitivity C-reactive protein turned out to be the best predictor of heart problems, even among people with "safe" cholesterol levels. After following the women for three years, the study showed that those with the highest levels of C-reactive protein have more than four times the risk of suffering a heart attack or blood-vessel problems than women with the lowest level of the inflammation marker. (The study was published in the March 23, 2000, New England Journal of Medicine.)

Previous research had revealed that men with the highest levels of this protein in their blood have three times the risk of heart attack and two times the risk of stroke compared to men with the lowest levels.

How does inflammation cause a heart attack or stroke? 

"Inflammation is now understood to play a critical role in the conversion of a stable cholesterol plaque into a worrisome, unstable lesion (injury)," says Dr. Ridker, who practices cardiology at Harvard-affiliated Brigham and Women’s Hospital in Boston. Inflammation can cause even small amounts of cholesterol plaque to rupture -- like an angry zit -- causing the formation of a blood clot at the rupture site which can block the artery and cause a heart attack or stroke. Even those with low cholesterol are vulnerable, because most of us have some plaque in our arteries by the time we reach middle age.

Cholesterol is still important. It tells you how much plaque is building up in your arteries. The level of inflammation indicates how likely the plaque is to rupture.

What Can You Do?

First, you can ask your doctor to order a blood test measuring your high-sensitive C-reactive protein (hs-CRP). Make sure you’re getting the "high-sensitivity" test, because the older test, simply called the "CRP," doesn’t measure inflammation as precisely as the high sensitivity version. "We’re talking about an extremely low level of inflammation – so low that the person has no symptoms and isn’t sick," says Ridker. "Until recently, we couldn’t even detect the inflammation with a blood test."

Doctors have been unsure who should be tested. But new federal recommendations are now being written which, the Associated Press reports, will urge wide spread testing of healthy, middle-aged Americans.

If your inflammation is higher than normal, try the well-known life style measures. If you smoke, stop. Exercise regularly, weight training and aerobics. "Cigarettes smoking drives [inflammation] up and exercise reduces it," says Dr. Ridker.

If you are overweight, reduce. "Obesity heightens the inflammatory process," says Ridker. Even gaining an extra 10 or 20 pounds can raise your inflammation level substantially. Diet is also a factor. Eating a diet low in saturated fat and cholesterol is important.

If your inflammation level is still too high, ask your doctor if you should take low-dose aspirin (81 mg). Aspirin reduces clotting ability and inflammation, according to Dr. Ridker. You may also be a candidate for one of the cholesterol-lowering statin drugs, such as Lipitor. Research  has shown that statins reduce inflammation as well as cholesterol.

"The good news is that this inflammation can be measured many years in advance of the first heart attack or stroke," says Dr. Ridker. "So you have lots of time to recognize the problem and prevent cardiovascular disease."

What are you waiting for?

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