By: Steven Nissen, MD
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“Inflammation.” You may have heard that word a lot lately and maybe you’ve wondered, “Do I have inflammation?” Actually, you’ve seen inflammation when you’ve injured yourself or gotten an infection. Inflammation as a normal bodily response can cause swelling, pain, fever or warmth.
We now believe inflammation plays a role in chronic diseases. It’s a risk factor in the development of coronary heart disease or CHD, which actually results from coronary artery disease or CAD. Inflammation isn’t the only culprit, however, since high cholesterol, high blood pressure, diabetes and smoking can also contribute to CHD.
The invisible enemy
Since I can’t examine you and determine right off the bat that you “have inflammation,” and you don’t know you have it, I often recommend a screening test that measures High Sensitivity C-reactive protein in the blood, or hs-CRP for short. It’s a marker for inflammation and we know from previous studies that patients with high levels of hs-CRP have an increased risk for heart attack and stroke. I often use hs-CRP when I am on the fence. If someone has an LDL such as 120; if they have a low hs-CRP, I may not treat. But if they have a high hs-CRP, a level that is more than 2, I would consider it an increased risk factor for the development of CHD. And based on the JUPITER trial, I would treat.
If your doctor says you have high hs-CRP, you may wonder, “So, what do I do about this?” I want to share good news—that statin drugs normally used to treat high cholesterol also help reduce inflammation. I also recommend other lifestyle changes, including:
- reducing high cholesterol levels
- controlling high blood pressure, diabetes, and your weight
- getting enough physical activity
- quitting smoking
- drinking alcohol in moderation
- eating heart-healthy: low in saturated fats, trans fats and sodium, like the Mediterranean diet
The idea with diet: is to choose more fruits and veggies, herbs and spices, whole grains and olives—All of these are a part of a “Mediterranean diet,”—along with nuts, seeds and legumes, as you consume less red meat and white flour.
Talk before you take
The takeaway point is that there is good evidence that patients with high levels of hs-CRP have an increased risk of heart disease and stroke. And there is evidence that treating patients with statins lowers their risk. However, hs-CRP is not the primary focus of treatment. Other risk factors, such as LDL, remain the target of treatment. We do not know at this time that targeting hs-CRP will reduce the risk although there are trials underway to look more closely at this. Also, statins may not be right for everyone, so that’s why I urge you to discuss risk factors and a treatment plan with your doctor.
You and your doctor can be a great team. Together, you can fight inflammation, and do so much more to help yourself achieve better heart health.