Role of inflammation -
Growing proof inflammation is a major risk factor for heart disease

A recent Associated Press story by Daniel Q. Haney has lead to numerous stories in the news and press concerning the importance of inflammation in the role of coronary artery disease development and progression.

Inflammation (triggered by environmental factors or genetic influences) causes a sequence of actions in the coronary artery such as, plaque rupture, thrombus formation and embolization into the blood vessels within the heart - placing one at increased risk for heart attack.

Dr. Paul Ridker, a cardiologist at Boston's Brigham and Women's Hospital has conducted several studies over the past few years, suggesting the importance of inflammation in triggering heart attacks. This may explain why those with a normal cholesterol level may still have a heart attack.

How is inflammation measured?
Inflammation can be determined by measuring your CRP level, short for "C-reactive protein," a protein found in the blood. Presence of CRP indicates a heightened state of inflammation in the body. Inflammation is a normal response to many physical states including fever, injury and infection - as well as the initiation and progression of cardiovascular disease. Elevated CRP is related to increased risk for heart attack, restenosis of coronary arteries after angioplasty, stroke, and peripheral vascular disease (PVD).

What does this mean in the future?
Cleveland Clinic interventional cardiologist Deepak L. Bhatt, M.D. recently conducted a study on patients undergoing percutaneous coronary intervention. He found that by pre-treating patients with high CRP levels with the antithrombotic agent clopidogrel prior to angioplasty and stenting, decreased the rate of myocardial infarction or death from 24 to 10.2 percent for patients with C-reactive protein levels in the highest quartile. Those who were diabetic benefited most by this strategy. This indicates a clinical role for measuring CRP prior to interventional procedures and targeting medical therapies accordingly.

For now, those at high risk for heart disease should consider including a CRP test in their standard lipid analysis. This includes people with a combination of other risk factors. In the future, we may see more people tested for CRP - discussion is currently underway to change national standards to include CRP testing in risk factor evaluations.

What is the treatment of high CRP?
Inflammation should be treated by lifestyle change, such as losing weight, exercising, controlling diabetes, stopping smoking, controlling high blood pressure, and reducing alcohol intake. Antithrombotic medications such as aspirin or clopidogrel may provide protection. Cholesterol-lowering statin drugs and ACE inhibitors may also reduce CRP. Your doctor will prescribe the correct medications and dosage to treat your condition.

Dr. Eric Topol, Department Chairman, Cleveland Clinic Heart Center states the new information about inflammation will, "change everything we do in heart disease." He adds that in the past, people talked about their cholesterol levels. In the next decade everyone will need to know their C-reactive protein level.

For more information:

• The Role of Inflammation in Coronary Stenting: Antithrombotics Used in Patients With Elevated C-Reactive Protein, Cardiac Consult, Fall 2001
  
• What is Ultra Sensitive C-reactive Protein (US-CRP)?
• Are you at risk for heart disease?
• Low-grade inflammation ready to move to the mainstream, theheart.org, August 7, 2002*
• A new Heart Danger, Daniel Q. Haney, Associated Press, reported in The Plain Dealer, Sunday, August 4, 2002*

©Cleveland Clinic Heart Center, 8/02
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