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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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