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Inflammation, C-Reactive Protein (CRP) and the Prevention of Cardiovascular Disease

John-David Kato, DC, MSc, ACSM-RCEP, CSEP-CEP. Nov 20, 2008.

Traditional risk factors such as smoking, high blood pressure, high LDL cholesterol, low HDL cholesterol, family history, sedentary lifestyle, and diabetes are associated with heart disease. However, these risk factors do not always identify who is susceptible to a heart attack and who is not. This has lead researchers to explore other risk factors and the medical means to modify them. The more risk factors we can identify and target, the better we will be able to prevent heart disease.

One such emerging factor is called high sensitivity C-reactive protein (hs-CRP, or CRP), for which physicians do not routinely order tests. CRP has been identified as an indicator for inflammation in the body and is measured by a simple blood test, just like cholesterol. Generally speaking, elevated CRP levels do not cause any symptoms. However, it is believed that the process of atherosclerosis that is responsible for cardiovascular disease such as heart disease, stroke, and peripheral vascular disease, is largely an inflammatory process. So if we can identify those with high levels of inflammation we can take steps to treat it, possibly lowering the risk of atherosclerosis.

Research over the last several years has shown that LDL cholesterol and CRP are relatively independent; one can be elevated without the other. The risk of cardiovascular disease can be higher in those with elevated CRP even when LDL cholesterol level is low. Furthermore, research has suggested that the measurement of both CRP levels and LDL levels appears to be a better predictor of cardiovascular disease than the measurement of either one separately.

A large-scale international study called JUPITER (Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin) was published today in the New England Journal of Medicine. It investigated whether Crestor (a statin medication) was able to reduce the risk of cardiovascular disease in healthy individuals with a high level of CRP but a healthy low level of LDL cholesterol. Statins have traditionally been used to lower LDL cholesterol. The goal of this study was to demonstrate that the anti-inflammatory effect of statins can reduce cardiovascular disease. This was to be determined by a measured decrease in CRP levels and an observed reduction in the occurrence of cardiovascular disease with the Crestor treatment. Earlier this year the pharmaceutical company funding the study, AstraZeneca, discontinued the study because the company claimed the data was showing unequivocal proof that the participants taking Crestor had a reduction in cardiovascular disease. It will no doubt receive a lot of attention and will affect how doctors prescribe statin medication.

Even as these results are reviewed by the medical community, it is important to remark that many previous studies show that, not only do a heart-healthy diet and regular physical exercise reduce many traditional risk factors for cardiovascular disease, but they can also reduce elevated CRP levels. So healthy lifestyle choices are always the first consideration in treatment regardless of whether your doctor determines you need medication or not.

As research continues, we will come to identify more of the causes and risk factors that are associated with strokes, heart disease and other cardiovascular diseases. The exciting contribution of the JUPITER study is that provides such strong evidence for the inflammation theory of atherosclerosis. Furthermore it shows that reduction of that inflammation in the body we can have a large impact in reducing the burden of cardiovascular disease on the population and save many lives.

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