Tame chronic inflammation

Heart attacks stem in part from inflammation, which can damage your arteries

Last updated: February 2013

Inflammation—an immune-system response that produces heat, swelling, and redness—appears to contribute to heart disease by potentially damaging the artery linings and speeding the growth of artery-clogging, clot-forming plaque deposits. "Statin" drugs such as lovastatin (Mevacor and generic) and simvastatin (Zocor and generic) might help prevent heart attacks not only by lowering LDL (bad) cholesterol but also by controlling inflammation.

And while chronic inflammation usually produces few obvious symptoms, a blood test for a substance called C-reactive protein (CRP) can help detect it. Here's how to know whether the test makes sense for you and what steps you can take to limit inflammation's damaging effect on the heart.

When to get tested

Research suggests that in general, the higher the CRP, the greater the risk of heart disease. But that doesn't mean that most people should be tested. For one thing, the blood test for CRP assesses inflammation throughout the body, so a high reading might not stem from inflammation in the blood-vessel walls. For example, a severely sprained ankle, a flare-up of arthritis, a urinary-tract or other infection, or even a large meal can cause temporary spikes in CRP.

Moreover, the test probably helps only a minority of people. For example, those already at high risk for heart disease who have a moderately elevated LDL level probably don't need it since they should usually take a statin regardless of the results. People at low coronary risk might not need it either because they probably wouldn't need to take a statin even if their CRP level was high. But if you're at moderate risk of coronary disease—because of a borderline LDL, for example, and perhaps one or more other risk factors, such as being a smoker or obese—knowing your CRP level might help you decide how aggressively to lower LDL with a statin. To determine your risk, talk with a doctor to determine your risk of having a heart attack or stroke in the next 10 years.

If you do get tested, make sure your doctor considers whether you have any other conditions that might elevate your CRP. A level of 2 milligrams per liter or higher is usually considered high.

Try lifestyle changes first

Even if you don't need to get your CRP measured, there's a good reason to make the lifestyle changes that appear to help limit inflammation.

Control weight, stay active. Simply digesting your food seems to trigger temporary inflammation—and the bigger the meal, the higher the CRP level might climb. Excess weight worsens the problem, since fat cells, especially around the gut, produce inflammatory proteins. On the other hand, people who lose weight tend to lower their CRP level. And exercise generates inflammation-fighting proteins, so it might help fight inflammation even if you don't lose weight.

Eat a heart-healthy diet. Saturated fat (from meat and dairy products) and trans fats (from partially hydrogenated oils) can raise the CRP level. Fruit, vegetables, whole grains, and the omega-3 fatty acids in fish might help lower it.

Manage stress. The CRP level and other markers of inflammation rise after stressful events and might be consistently elevated in people who experience chronic stress, loneliness, or, as an Israeli study found, constant fear. Other research has linked depression with elevated CRP levels.

Quit smoking. Smoking might harm the arteries in part by causing inflammation.

Rein in infection. Research hints that a bacterium known as H. pylori, as well as germs that cause periodontal disease, influenza, pneumonia, and the sexually transmitted disease chlamydia, might increase the risk of heart disease. It makes sense to protect yourself against those infections and others. So talk with your doctor about getting vaccinated against influenza, pneumonia, hepatitis B and, if you're a woman, the human papilloma virus (HPV). Finally, practice good dental hygiene and take steps to avoid sexually transmitted diseases or get treatment for them.

When to consider drugs

If your doctor has ruled out noncardiac causes of an elevated CRP and lifestyle changes haven't helped reduce them, some people could consider taking a statin.

In February 2010, the FDA approved one of those drugs, rosuvastatin (Crestor), for men 50 and older and women 60 and older who have a normal LDL level (under 130 milligrams per deciliter) but a high CRP level plus at least one additional traditional risk factor. For other people who are at moderate coronary risk and have a borderline LDL, an elevated CRP might also tip the scales toward drug treatment.

If you do need a statin, in general our Best Buy Drugs recommendations are for generic versions of lovastatin, pravastatin, and simvastatin for most people, and atorvastatin (Lipitor) for people who have had a heart attack, angioplasty, or heart bypass surgery and need substantial reductions in LDL. Those drugs lower LDL and CRP. They also have longer safety records than rosuvastatin and are usually less expensive.

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