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Jan. 17 issue - Two new studies confirm what doctors and scientists have long suspected—that inflammation may be just as important as cholesterol in causing heart attacks and strokes. The research on C-reactive protein (CRP), published in the Jan. 6 issue of The New England Journal of Medicine, was conducted in people with known coronary artery disease.
Until recently, doctors primarily focused on lowering blood levels of LDL ("bad") cholesterol and raising HDL ("good") cholesterol to slow down the growth of the cholesterol-filled plaques that cause heart disease by impairing blood flow in the coronary arteries. The new CRP research does not change the importance of moving LDL and HDL cholesterol in the right directions. If anything, the target for LDL keeps moving down.
But factors other than cholesterol also increase the risk of heart attacks, and research over the past decade indicates that inflammation is one such culprit. (Since inflammation itself cannot easily be measured, doctors use blood tests for CRP, a marker for inflammation, as a proxy.) The new studies showed that even when LDL cholesterol levels were normal, patients with the lowest CRP levels had slower progression of heart disease and fewer heart attacks and deaths from heart disease.
The patients in the studies were using the cholesterol-lowering drugs known as statins, which, researchers say, also lower CRP. Statins thus provide two potent weapons against heart disease, and the new research will likely cause doctors to order more CRP blood tests and more prescriptions for statin drugs.
Statins, however, are not the only way to lower CRP; exercise, a healthy diet and quitting smoking also reduce it. Men who exercise regularly have much lower CRP levels than sedentary men. (The research was done just on men, but the results probably hold true for women.) Diets low in calories and saturated fats—particularly diets containing plant sterols (found in avocados), viscous fiber, soy protein and nuts—also decrease CRP. Besides statins, medications found to lower CRP include beta blockers, the diabetes drugs called thiazolidinediones and possibly aspirin. Hormone therapy raises CRP.
So which matters more, your cholesterol levels or CRP level? They are both important. The CRP blood test, like cholesterol levels, can be ordered by your doctor. Though CRP testing is easy to perform and inexpensive, there is no evidence to support routine screening of all adults at this time. However, if you have heart disease already, the new studies say it is reasonable to have your CRP level checked. If it is high, you may want to consider statin treatment even if your cholesterol is normal. What if you do not have heart disease but do have risk factors for heart disease (such as high blood pressure or smoking)? Would you benefit from statins if your CRP test is high? At this point, we do not know, although some doctors will likely recommend them. But powerful as statins are, a healthy daily dose of exercise and the right foods are more powerful still.
Lewine is chief editor for Internet publishing at Harvard Health Publications at Harvard Medical School. For more about Harvard Health Publications, see health.harvard.edu.
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