The Inflammation Connection--Statins, CRP & the JUPITER Study. The Non-Prescription Way to Prevent Heart Attacks & Strokes

This is part two of a post on the JUPITER Study & statins--to read part one click here:
 

Statins Cut Stroke & Heart Attack Risk in Half in Healthy Individuals with Low Cholesterol & Elevated CRP Levels (Inflammation)--Landmark Study Rocks the New Orleans American Heart Association Conference posted Nov. 9, 2008

 

"My own research has shown that for all the statins, they have this interesting phenomena. What we call two-fer drugs---they both lower cholesterol and they lower the inflammatory process."

 -Dr. Paul Ridker, lead author of the JUPITER STUDY, November 2008-

"From 25 to 30 million healthy, middle-aged American are at far higher risk (of heart disease) than they and their doctors understand them to be, because we're not taking inflammatory factors into account."  

-Dr. Paul Ridker, New York Times November 14, 2002-

"C-Reactive protein (CRP) may be the most predictive for cardiovascular killers such such as heart attack, stroke, and vascular disease.  Studies have shown that people with elevated CRP run two times the risk of dying from cardiovascular-related problems compared with those who have high cholesterol levels. Combine a cholesterol burden with a markedly elevated CRP and your risk of heart attack and stroke increases by a factor of nine."

-Dr. Stephan Sinatra, "Statins: grossly overprescribed for cholesterol and underprescribed for internal inflammation" The Sinatra Health Report, Sept. 2002-

Just to recap:  The JUPITER Study enrolled healthy volunteers, not at risk for heart attack or stroke under current guidelines, and treated them with statins. The 18,000 men & women in the study had low LDLs & weren't hypertensive, but they did have CRP (inflammation) levels over 2.0, which as you can see below put them in the intermediate risk category for cardiovascular disease.  The problem is, most physicians usually do not test for CRP--especially for people with normal cholesterol levels.

Less than 1.0 mg/L = Low Risk for CVD
1.0-2.9 mg/L = Intermediate Risk for CVD
Greater than 3.0 mg/L High Risk for CVD

The results were amazing--the average risk for heart attack and stroke was cut in half.  In fact, the study was halted because of its overwhelming success. The volunteers taking the placebo were given the opportunity to also take the statins.

Dr. Ridker's most important point:  "The inflammation is telling us the likelihood that plaque could rupture.  And that rupture process is what shuts off the oxygen to your heart, or to your brain, and causes that heart attack and stroke.  We now teach Harvard Medical students about atherosclerosis in a very different way than I was taught.  We now teach the students it's a disease of cholesterol and it's a disease of inflammation."

Was the Study Stacked with Overweight People with High Blood Pressure Who Didn't Exercise?

No!  This is straight from Dr. Ridker & why we need to pay attention to this study.

“One of the most remarkable findings here was that we had about 6500 individuals who have an increased level of hs-CRP and no other major risk factors according to our current guidelines-- and that group got approximately a 40% reduction. It says to us that this inflammatory process, which we can’t feel, we can’t tell, we don’t do well, is driving off a lot of this.”
This group had low LDL levels, was of normal weight, non-smoking, & non-hypertensive.

Are the Results Questionable Because a Drug Company Sponsored the Research & Ridker Invented the hs-CRP Test?

No!  As for questions about AstraZeneca’s sponsorship, it was a randomized double-blind, placebo-controlled trial. According to Ridker:

“There is no way the sponsor can deal with it (the study or data). The company never had access to the unblinded data until after the manuscript was written & submitted. It was as tight of control as possible.”

Ridker developed the hs-CRP test precisely because he knew inflammation was key to the development of heart attacks & strokes.

How Do Statins Lower the Heart Attack & Stroke Risks in People Who Already Have Normal Cholesterol?

As Ridker says, statins are 2-fer drugs.  It's a happy coincidence that they not only lower cholesterol, but they also lower inflammation.  Evelyn Tribole, MS RD points out that:

While statins are well known for lowering cholesterol, they also blunt the effects of excessive omega-6 fats, which are at the root of inflammation. For example, statins prevent the release of arachidonic acid from the LDL-cholesterol (Kim, Am J Clin Nutr 2008). Arachidonic acid is the potent omega-6 fat, which increases blood clots, arrhythmias and stiffens arteries.

Let Me Get This Straight.  Why Would I Want to Take a Drug That Has Side Effects If I Just Want To Lower My Inflammation? Is There a Non-Drug Way to Lower Inflammation Without Risks?

Exactly right!  Dr. Ridker and most cardiologists will be the first ones to advise going to the gym, changing your diet & lifestyle before getting on a lifetime course of statins.

There are many ways to naturally lower your inflammation and I'll list them for you at the end of this post.  And guess what?  The best part is that the natural ways to lower inflammation aren't just 2-fer drugs like the statins, they're  Five-fer non-drugs! 

Not only will they cut your risk of heart disease & stroke, but they just may cut your risk for cancer, Alzheimer's, joint pain, depression, hypertension, and perhaps help you live longer, as well!

An anti-inflammatory diet, exercise, adequate Vitamin D, stress control & solid sleep will lower your CRP levels--cut your inflammation--make you healthy--and put you in a good mood.  A Happy Healthy Long Life!!  Honestly, I know it sounds like snake oil & junk science, but it's backed by research study after research study. 

Why take a 2-fer drug like a statin, when you can potentially prevent 5 diseases/conditions with diet & lifestyle changes?  Unless, you have to take a statin--in which case, you gotta do what works for you.  If I had to take a statin, I absolutely would. It's a powerful drug with a good safety profile that has benefited many. But there is an alternative.

I Thought the Body Needs Cholesterol to Properly Function.  What Happens If My Cholesterol is Normal & I Lower It Too Much?

According to a Phd Candidate in Nutrition at UNC Chapel Hill:

"The target of statins is a cholesterol synthesis enzyme. This biochemical pathway is also crucial for formation of Vitamin D, cellular membranes, bile acids and steroid hormones. It also is very important for nerve signaling.

So as statins target cholesterol synthesis, they are also affecting these secondary processes. It is no surprise that some people are feeling awful, have pain, etc.

I hope both physicians and patients are cognizant of this and are thoughtful in their decision to use this controversial drug."

In a Nutshell, How Can I Lower Inflammation and Reduce My Risk of Heart Disease & Stroke?

• First, have a hs-CRP test to see what your level of inflammation is. If it's over 1, make these changes, and then follow-up to see if you are able to lower your inflammation with diet & lifestyle modifications.  If not, then you may have to go the statin route.
  

• Exercise. It will lower inflammation & triglycerides. It will raise your good HDLs & increase your telomeres--which slows down aging. 

• Eliminate bad fats.  Cut out saturated fat--red meat (unless it's grass-fed)--full-fat dairy foods.  Eliminate trans fat--fried foods--commercially prepared baked goods.

• Eliminate the Omega-6 oils: safflower, sunflower, corn, cottonseed & peanut oils.

• Use canola, flaxseed or walnut oil in small amounts when you do need to use oil.
  

• Increase you omega-3 consumption.  Eat wild salmon or other high omega-3 fish twice a week. Don't eat farm-raised salmon or tilapia, which are high is Omega 6's. Add ground flax seed and a small amount of walnuts.  Supplementing with highly refined pharmaceutical grade fish oil capsules will lower triglycerides and lower inflammation.  Check with www.consumerlab.com for the best brands. OmegaBrite & Minami brands were given the "very highest" ratings by Consumer Labs.

• The ratio of Omega 6's to 3's should be 2:1, or ideally 1:1.  Currently, for most Americans, the ratio is 17:1 in favor of heart-disease-causing Omega 6's.

 

• Be sure to ask your doctor for the serum 25-hydroxyvitamin D test to measure your Vitamin D level & based on that decide if you need to get a full 1000 IUs of vitamin D  (my doctor recommends up to 2000 IUs for me, given my test results & Northern gray location)

• Get enough sleep & treat sleep apnea if you have it.

• Take a multivitamin.

• Get 20 grams of fiber for every 1,000 calories you eat per day. That's 30-40 grams of fiber a day, depending on how many calories you eat.

• Stay hydrated.

• Eat lots of fruit & vegetables (7-9 a day) high in antioxidants--kale, collards, Swiss chard and spinach are highest in this category.  See Dr. Fuhrman's ANDI scale for fruits & veggies highest in anti-oxidants.  Click here

• Garlic

• Foods high in magnesium--400 mg a day is needed.  Consider taking a supplement if you aren't getting adequate amounts in your diet

• Phytostanols or sterols--they displace the cholesterol in your arteries.  Can be found in food products enriched with Corowise  or in Endur Phytosterol capsules.

• 1/2 regular aspirin (162 mg) or 2 baby aspirins every day if you're a man over 35 or woman over 40 (use with caution because of gastric upset & bleeding risk) Talk to your physician about this one!

• Floss your teeth daily

• Take a curcumin capsule (a component of the spice turmeric which has anti-inflammatory properties)

• Eat only whole grains--but try to keep consumption low.  Eliminate white flour, white rice, sugared soda.

• Cut back on sugar. Even too many fruits can raise triglycerides in some people. If your triglycerides are high--eat whole fruit (not juice) & limit quantities to 2/day. Increase your vegetable intake.

• Watch your alcohol consumption. In some people alcohol dramatically raises triglycerides.  You'll only know if you respond to alcohol this way by eliminating it, & then measuring your triglycerides.

• If you're overweight, losing just 5% - 10% of your weight will lower your triglycerides.  When you lose weight, belly fat is the first to go & that's associated with higher triglycerides & inflammation. Women should try get their waist to less than 31 inches, men under 40 inches. For more incentive to ditch the belly fat, click here.

To read a very enlightening transcript of Dr. Paul Ridker and Dr. Mark Hlatky about the JUPITER Statin study on NPR's Science Friday, November 14, 2008, click here.

If you missed my post on reversing heart disease that explains how you can have a heart attack or a silent stroke even if you think you don't have heart disease or atherosclerosis, click here.

If you missed my post on "Do Statins Make You Stupid? Asks Wall Street Journal & the New York Times", click here.

Helpful books on preventing/treating heart disease through diet & lifestyle changes.

What You Must Know about Statin Drugs & Their Natural Alternatives.  Dr. Jay S. Cohen.

The Spectrum. A Scientifically Proven Program to Feel Better, Live Longer, Lose Weight & Gain Health.
Dr. Dean Ornish.

Prevent and Reverse Heart Disease.  Caldwell B. Esselstyn, Jr.

The Queen of Fats. Why Omega-3s Were Removed from the Western Diet and What We Can Do to Replace Them.  Susan Allport.