Is Chronic Inflammation a Risk Factor for Heart Disease?
This article originally appeared in Be Well, a health
information newsletter published for members of the Greater Marlborough
Ask just about anyone to name the risk factors for cardiovascular disease,
including heart disease and stroke, and you are likely to hear them repeat the
well-known ones, such as high blood pressure, obesity, diabetes, smoking and
high cholesterol. However, based on exciting new medical research, it appears
that chronic low-level inflammation in the body may take its place alongside
these other well-known risk factors.
During the last few years, researchers have noticed what appears to be a
strong link between chronic inflammation and atherosclerosis, a process in which
fatty deposits build up in the walls of arteries. Atherosclerosis is an
underlying factor in many heart attacks and strokes.
Chronic inflammation can be measured by a blood test called "hsCRP," which
measures the level of C-reactive protein in the body. This protein is closely
associated with inflammation. Many doctors now believe that testing hsCRP levels
can be a new way to help assess an individual's likelihood of developing
cardiovascular disease. According to the American Heart Association, some
scientific studies have found that the risk for heart attacks in people in the
upper third of hsCRP levels is twice that of those whose hsCRP is in the lower
"Right now, the evidence seems to indicate that inflammation, as measured by
hsCRP, is highly correlated with an increased risk of cardiovascular disease and
events, such as heart attacks. In fact, elevated hsCRP levels appear to be as
strong as a high level of low density lipid cholesterol (LDL-C), the so called
‘bad cholesterol,' in predicting one's risk for a cardiac event," explained
Daniel Carlucci, MD, a board-certified cardiologist on the Marlborough Hospital
medical staff. "I've been ordering hsCRP tests for many of my new patients,
particularly younger ones, to help me assess their risk. I have also been
following the hsCRP trends of my established patients once treatment has been
Although still not 100 percent certain, researchers now believe that chronic
low-level inflammation may affect the body's arteries, leaving them susceptible
to fatty build up. "The likely explanation is that inflammation causes a
breakdown in the membrane of the artery's wall, allowing cholesterol to take
hold and plaque to build up," said board-certified and Marlborough Hospital
affiliated cardiologist Howard Kirshenbaum, MD. "When a plaque ruptures, a clot
forms, cutting blood flow to the heart muscle and causing a heart attack."
The good news is that cholesterol-lowering medications, known as "statins,"
are believed to also reduce chronic inflammation and may provide an extra layer
of protection from heart disease. The benefits of statin drugs may be
particularly important for individuals who have a normal or low level of LDL-C
cholesterol," yet have a high level of inflammation. Preliminary studies
indicate that despite the relatively low level of bad cholesterol, the presence
of chronic inflammation still places these individuals at an increased risk for
"Most people know their cholesterol numbers, but few know if they have
chronic inflammation as measured by a hsCRP blood test," said Dr. Carlucci. "Yet
there is now interesting evidence that inflammation is a strong risk factor for
cardiovascular disease, even in people with relatively good LDL-C numbers. This
is why we, as physicians, are looking at hsCRP more closely."
A clinical study called the "Jupiter Trial" is currently underway at major
medical centers across the country, including at UMass Memorial Medical Center
in Worcester, to scientifically determine how well anti-cholesterol medications
prevent first heart attacks in individuals with normal to low levels of LDL-C
but high levels of hsCRP.
"Using cholesterol lowering medications to control inflammation is another
promising avenue of intervention in combating heart disease," concluded Dr.
Kirshenbaum. "This is very exciting research that conceivably could
revolutionize the treatment of heart disease. By using statins to control
at-risk patients' cholesterol and inflammation now, we are stepping in early and
possibly preventing heart disease from occurring."