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STUDY: Study finds condition is top trigger, worse than cholesterol
JOURNAL: New England Journal Of Medicine
AUTHORS: Dr. Paul Ridker
ABSTRACT: A landmark study offers the strongest evidence yet that simmering, painless inflammation deep within the body is the single most powerful trigger of heart attacks, worse even than high cholesterol.
COMMENTARY: The latest research is likely to encourage many doctors to make blood tests for inflammation part of standard physical exams for middle-aged people, especially those with other conditions that increase their risk of heart trouble.
The study, based on nearly 28,000 women, is by far the largest to look at inflammation’s role, and it shows that those with high levels are twice as likely as those with high cholesterol to die from heart attacks and strokes.
Over the past five years, research by Dr. Paul Ridker of Boston’s Brigham and Women’s Hospital has built the case for the “inflammation hypothesis.” With his latest study, many believe the evidence is overwhelming that inflammation is a central factor in cardiovascular disease, by far the world’s biggest killer.
“I don’t think it’s a hypothesis anymore. It’s proven,” said Dr. Eric Topol, chief of cardiology at the Cleveland Clinic.
Inflammation can be measured with a test that checks for C-reactive protein, or CRP, a chemical necessary for fighting injury and infection. The test typically costs between $25 and $50.
Diet and exercise can lower CRP dramatically. Cholesterol-lowering drugs called statins also reduce CRP, as do aspirin and some other medicines.
Doctors believe inflammation has many possible sources. Often, the fatty buildups that line the blood vessels become inflamed as white blood cells invade in a misguided defense attempt. Fat cells are also known to turn out these inflammatory proteins. Other possible triggers include high blood pressure, smoking and lingering low-level infections, such as chronic gum disease.
Inflammation is thought to weaken the fatty buildups, or plaques, making them more likely to burst. A piece of plaque can then lead to a clot that can choke off the blood flow and cause a heart attack.
For the first time, Ridker’s study establishes what level of CRP should be considered worrisome, so doctors can make sense of patients’ readings. However, experts are still divided over which patients to test and how to treat them if their CRP readings are high.
Some, such as Dr. Richard Milani of the Ochsner Clinic in New Orleans, recommend a CRP check for virtually anyone getting a cholesterol test. “If I have enough concern to check a patient’s cholesterol, it seems naive not to include an inexpensive test that would give me even more information,” he said.
Ridker said he believes a high CRP reading can help doctors persuade people with low cholesterol that they still need to diet and exercise.
“The CRP test can predict risk 15 to 25 years in the future,” Ridker said. “We have a long time to get our patients to change their lifestyles, and the change does not have to be huge — modest exercise, modest weight loss and stop smoking.”
Ridker’s latest study is based on an eight-year follow-up of 27,939 volunteers in the Women’s Health Study. About half of heart attacks and strokes occurred in those with seemingly safe levels of LDL, the bad cholesterol.
The lowest risk was in women whose CRP readings were below one-half milligram per liter of blood. It more than doubled when readings went over about three.
You've heard it before: Eat sensibly and get some exercise. But new findings on the dangers of inflammation offer still another reason to shape up.
Doctors say that both inactivity and obesity increase inflammatory proteins that can trigger heart attacks. People can substantially lower their levels of these proteins simply by improving their living habits. Even modest changes help, though studies show that vigorous exercise and a strict diet can cut inflammation levels in half in just three months.
Some research suggests that moderate alcohol consumption and fish oil are good for inflammation levels.
So too are giving up smoking and keeping blood pressure under control.
A variety of drugs and supplements may also do the trick. Ask your doctor to test you.