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Study Adds Evidence of Inflammation's Role in Heart Attacks

Experts plan to make recommendations for testing patients
By Daniel Q. Haney
The Associated Press

BOSTON - 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.

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 is based on tests of nearly 28,000 women and by far the largest to look at inflammation's role.  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."  Many health experts now 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 $25 to $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 those inflammatory proteins.  Other potential 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.

In March, the heart association and the Centers for Disease Control and Prevention held a meeting of 50 experts to review the evidence and make recommendations on CRP testing.  Although it hoped to be finished this month, the committee went back to the drawing board after learning last week of Ridker's latest results, which are being published in today's New England Journal of Medicine.

A skeptical editorial in the journal by Dr. Lori Mosca of Columbia University questioned the need for widespread testing, at least until more studies are done to show that lowering CRP actually saves lives.

Such studies are planned.  Until then, Ridker said he believes a high CRP reading can help doctors convince people with low cholesterol that they still need to diet and exercise.

"The CRP test can predict risk 15 to 20 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."

Reprinted with permission.

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