The Real Culprit in Cardiovascular Disease
We've been drilled so long and so loudly about watching cholesterol levels that many people whose levels are low assume that they are automatically out of the woods and will avoid cardiovascular disease. Wrong! Only about half of people who have heart attacks have abnormal cholesterol (blood lipid) levels. The latest research shows that the real culprit is inflammation. Scientists have long suspected that cholesterol is not the holy grail of heart disease that it has been made out to be, and now studies at two major medical institutions confirm that elevated C-reactive protein (CRP), a marker of inflammation, also is a key risk factor. Inflammation plays a major role in the development and progression of artery-clogging atherosclerosis, the chief underlying cause of heart attack and stroke.
The bottom line: Independent of other risk factors, the higher your CRP level, the higher your risk for cardiovascular catastrophe. The good news is that adding CRP screening to lipid screening in those at risk can identify inflammatory problems sooner, so you can take aggressive steps to control them. In the January 6, 2005 issue of the New England Journal of Medicine, two different research groups came to similar conclusions about CRP. At Brigham and Women's Hospital in Boston, a team examined the cases of 3,745 coronary disease patients to compare the impact of two cholesterol-lowering drugs -- atorvastatin (Lipitor) and pravastatin (Pravachol). They found that the choice of medicine was not as significant as getting LDL ("bad") cholesterol numbers below 70 in high-risk patients... and lowering CRP to below 2 mg per liter of blood. In those who reached the LDL target, the risk for recurrent heart attacks or dying from a heart attack or stroke was reduced by another 50% when the CRP level was lowered to 2 mg. A Cleveland Clinic Foundation study involved 502 heart disease patients who took statins for 18 months. Ultrasounds of their arteries confirmed that lower cholesterol levels led to slower progression of arterial blockage. Significantly, the tests also indicated that "the decrease in CRP levels was independently and significantly correlated with rate of progression." According to cardiologist Steven Nissen, MD, author of the Cleveland Clinic study, these two trials strongly suggest that we should focus statin therapy on reducing CRP, not just cholesterol. He adds that we must now begin to think of CRP as an accelerator of disease activity, not just a marker associated with high risk. Although a simple, inexpensive blood test is all that is required to measure CRP, most doctors do not monitor CRP as closely as cholesterol. American Heart Association (AHA) guidelines recommend that physicians consider CRP testing for people at intermediate risk for cardiovascular disease (defined as having a 10% to 20% risk for a heart attack in the next 10 years based on current health status and history). If you are in this category, your doctor will inform you. Risk factors that can place you in this category include cholesterol numbers, high blood pressure and diabetes.
Still another reason to watch CRP: Other research suggests that elevated CRP may be an early indication of type 2 diabetes. Dr. Nissen emphasizes that it is essential to get both cholesterol and CRP under control. Fortunately, many of the same general lifestyle recommendations that enhance cardiovascular wellness overall also can help reduce CRP levels...
*Maintain an appropriate weight. CRP increases as weight increases, and Dr. Nissen points out that reducing intra-abdominal fat can drop CRP by 40% to 50%.
*Engage in regular exercise. One more reason to get off the couch is to lower your CRP, advises Dr. Nissen.
*Follow a healthful diet. While diet is not directly linked with CRP, a well-balanced diet is necessary to get your weight under control.
If CRP remains elevated even after lifestyle adjustments, your doctor will consider medication. At present, statins (the same drugs prescribed to lower cholesterol) are the only drugs known to reduce CRP. Another drug awaiting FDA approval -- the anti-obesity, anti-smoking rimonabant (Acomplia) -- shows promise in lowering CRP, and chances are that current research will spark greater interest in developing more new medications. Contributing editor Andrew L. Rubman, ND, adds that there are also a number of nonprescription options for reducing CRP, including antioxidant, omega-3 and vitamin B-12 therapies, to name but a few. He suggests trying and exhausting all natural options before resorting to problem-prone statins. As we came to the close of our conversation, I asked Dr. Nissen if we are closer to an answer to cardiovascular disease. Will lowering cholesterol and CRP keep us from having a heart attack or stroke? He told me that although this offers some of the best protection we have available today, scientists still have a lot to learn about cardiovascular disease, and there are many risk factors out there that we have yet to uncover. In the meantime, take advantage of all that we do know -- this also means controlling blood pressure and diabetes, managing stress efficiently and staying away from cigarettes. Once again -- take good care of your body, and it will take good care of you.