Inflammation: More Important than Cholesterol

At the American Heart Association conference in New Orleans, researchers from the Jupiter study reported that statin drugs caused people with normal cholesterol but with high C-reactive protein levels to suffer 54 percent fewer heart attacks, 48 percent fewer strokes, 46 percent fewer angioplasties or bypass operations and 20 percent fewer deaths from any cause than those taking placebos (NEJM, November 9, 2008). The results were so dramatic they made the front page of the New York Times, Washington Post and many other newspapers.

A C-reactive protein test (CRP) measures inflammation. Inflammation is caused by anything that keeps your immunity active such as chronic infections or anything that damages tissue such as smoking, having high cholesterol or high blood pressure. Last week I reported a theory to explain why eating mammal meat causes inflammation and is associated with increased risk for premature death, cancers and heart attacks. Meat contains a molecule called Neu5Gc that humans do not have, so the immune system of humans attacks this protein as if it was an invading germ and eventually attacks the host itself to destroy the blood vessels and increase risk for heart attacks and strokes.

Many scientists feel that inflammation is a stronger predictor of heart attacks than high cholesterol levels. At present, statins are prescribed to treat people with heart disease or high cholesterol. This study shows that they prevent heart attacks in people with high CRP and normal cholesterol levels, presumably because statins reduce inflammation. About 7 million people in the US have normal cholesterol and high CRP. Treating them with a brand-name statin would cost each $116 a month or $9.7 billion a year, and prevent about 28,000 heart attacks, strokes and cardiovascular deaths each year.

Rather than just writing a prescription for statins, I think doctors should ask why a patient's CRP is elevated and try to lower it with lifestyle changes or treatment of any underlying chronic infection.