Burst of inflammation

Like a wildfire, the word “inflammation” roared through the health world this week after the New England Journal of Medicine released a study with convincing evidence that measuring the levels of a marker for inflammation called C-reactive protein (CRP) may be a more accurate risk assessment for heart attack than elevated LDL cholesterol levels. Ah, but as we’ll see, there’s a little more to it than just that.

Previous studies have shown that inflammation may be an aggravating factor in creating the blood clots that commonly lead to cardiovascular (CV) events. And because it’s now well known that C-reactive protein is produced by the liver in response to inflammation, CRP is regarded as one of the markers that indicates a risk for CV complications. With this as a background, researchers at Brigham and Women’s Hospital and Harvard Medical School set out to compare the accuracy of LDL cholesterol to CRP in predicting the risk of heart attack and other CV events.

The Brigham/Harvard team enlisted more than 27,000 apparently healthy women, enrolled in Brigham’s ongoing Women’s Health Study. At the outset of the research, LDL cholesterol and CRP levels were measured. For eight years the women were followed to note the occurrence of heart attack, stroke, and other CV events.

Researchers found that subjects with the highest CRP levels were more than twice as likely to experience an adverse cardiovascular event than those with the lowest levels of CRP. When subjects with high CRP levels were compared to subjects with high LDL cholesterol, the data suggested that the CRP reading is a more reliable predictor of CV events. Furthermore, subjects with high CRP were found to be at higher risk, even when their LDL was low (contrary to what the conventional thinking on cholesterol would have us believe).

As we’ve often stated in e-Alerts and HSI Member Alerts, the medical mainstream has had a cholesterol mindset for many years. So even though it’s well known that cholesterol is not the most significant marker for poor cardiovascular health, cholesterol has been touted as the primary marker to watch. The pharmaceutical companies provide the strongest incentive to focus on cholesterol because of their very aggressive promotion of statin drugs, which have been shown to lower cholesterol levels.

So is this new report the beginning of the end of cholesterol and statins glory days? Absolutely not.

For one thing, the authors of the study state that because CRP and LDL measurements tend to reveal different high risk groups, screening for both of the markers gives a more complete picture of cardiovascular health than either one alone. The authors also indicate that CRP and LDL may work hand in hand; with LDL promoting the onset of atherosclerosis (the progressive narrowing and hardening of the arteries), and inflammation (indicated by CRP) aggravating atherosclerosis and creating blood clots.

If this feels like a set up – you’re right.

This last Monday, at the American Heart Association annual meeting in Chicago, the lead author of the CRP study – Dr. Paul Ridker of Brigham and Women’s Hospital – announced that he will be the primary investigator in a major four-year study of 15,000 subjects to examine the possibility that CRP levels can be lowered with the use of statins. The FDA will oversee the trial, which is being sponsored by AstraZeneca, the maker of the rosuvastatin – the drug that will be used in the trial.

Some things never change.

So while it would appear that the glory days of statins are far from over, that shouldn’t overshadow the value of this new research that brings CRP into the mainstream spotlight. In the same issue of the New England Journal of Medicine that the CRP study appears in, an editorial by Lori Mosca, M.D., states that CRP has also been associated with obesity and insulin resistance. If this marker really does prove to be reliable across a broad range of important health issues, we’ll obviously be hearing much more about CRP as time goes by.

Yesterday morning, Doctors Mosca and Ridker participated in a panel discussion about CRP on National Public Radio. Most of their discussion covered the main points about CRP that have been reported this week. But one comment by Dr. Mosca jumped out: She said that an intake of omega-3 fatty acids has been associated with lower levels of CRP.

I thought: Not too loud, Dr. M. – that’s not the sort of thing that AstraZeneca wants the public to hear.

To Your Good Health,

Jenny Thompson
Health Sciences Institute