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

 

*For Part 2 of this post: "The Inflammation Connection--Statins, CRP & the JUPITER Study.  The Non-Prescription Way to Prevent Heart Attacks & Strokes"  Click HERE.

The JUPITER study is one of the most important clinical trials in the long history of statin studies, and its results are likely to CHANGE THE GUIDELINES FOR PRESCRIBING STATINS TO HEALTHY INDIVIDUALS.

"Ideally, if a patient comes to me with normal LDL-cholesterol levels—(in JUPITER, the median LDL-cholesterol level was 108 mg/dL)—I tell him to keep doing what he's doing and to go about his business. Now, what happens when that same patient arrives in my office and I know his CRP is elevated? I know that treating him with intensive statin therapy, despite what the guidelines state, is going to cut his risk of cardiovascular morbidity and mortality in half."

Dr. Steven Nissen of the Cleveland Clinic

Currently, if you walked into a physician's office with normal weight, normal blood pressure, normal cholesterol, you'd be congratulated for your good health and told to keep doing what you're doing.

If your doctor doesn't check your CRP (C-Reactive Protein) levels, which measures inflammation in your blood vessels, he doesn't  know the full extent of your risk for cardiovascular disease.  Levels over 3 indicate inflammation, and high risk for cardiovascular disease. Levels between 1.0-2.9 indicate an intermediate risk. Currently, CRP testing is not widespread, and it's usually reserved for people with suspected cardiovascular disease or risk.

Now all that is about to change!  At the November 9, 2008 meeting of the American Heart Association evidence was presented that will forever change the standards for testing CRP levels and prescribing statins to prevent heart attacks &  strokes in healthy individuals.   The JUPITER (Justification for the Use of Statins in Primary Prevention) Study looked at almost 18,000 men & women with low LDL levels (median 108 mg/dL), and CRP levels greater than 2.0 mg/L. 

The group that was put on a moderate dose of statins (20 mg of Crestor) decreased their cholesterol levels, lowered their CRP levels, reduced their triglyceride levels and cut their risk of heart attack and stroke in half.  To read the full report click here.  To the read the accompanying article published online today in the New England Journal of Medicine, click here.

These days physicians know that it's not just low cholesterol numbers that are key to preventing cardiovascular disease. Besides the usual contributing suspects like smoking, high blood pressure, excess weight and diabetes, the new star culprit is INFLAMMATION.  It's been a suspect for awhile, and its presence explains why a perfectly healthy individual can all of a sudden suffer a heart attack.  From now on you won't just know your cholesterol numbers, but you'll also pay attention to your CRP levels.  And statins do a great job of lowering CRP levels.

Yes, you can exercise, have a healthy weight, normal cholesterol levels,  but still be at risk for  cardiovascular disease if your veins and arteries are inflamed.  It's easy to find out what your CRP (C-Reative Protein) levels are through an inexpensive test.

If your CRP is over 3 there is inflammation and you need to do something about it.  My physician is even more pro-active, looking for a level below 1.0.  Dr. Mark Liponis, the medical director of Canyon Ranch aims for a level below 0.7.

What Does the Cleveland Clinic Heart and Vascular Institute Say about CRP?

The following Q & A's were reviewed by Dr. Stanley Hazen M.D., Ph.D., Section Head of Preventive Cardiology at the Cleveland Clinic Heart & Vascular Institute

Q: What is C-reactive protein? How does it relate to heart disease?

A: The body produces C-reactive protein (CRP) during the general process of inflammation. When a disease called atherosclerosis damages arteries around the heart, they become inflamed, which triggers CRP production. For years we thought that diseased arteries around the heart slowly narrow, then clog or collapse and cause a heart attack. While this does occur, it is much more rare than had been anticipated. And that theory didn’t explain the patients who were fine one day, but had a heart attack the next week. We have since found that in some people inflamed, softened artery walls develop weak areas that can rupture suddenly, causing a heart attack. Also, plaque can build up quickly in inflamed arteries, increasing the risk of blood clots.

THE INFLAMED VESSEL In the blood vessel above, cholesterol buildup is present (yellow); but that’s not the only heart disease risk factor pictured. Doctors are also turning their attention to the diseased area of the vessel marked by inflammation (dark red and white).

Q: How do doctors test for CRP?

A: Physicians measure CRP with a simple, convenient blood test that does not require fasting. General CRP blood testing has been around for years, but only one kind, the high-sensitivity C-reactive protein (hs-CRP) test, helps determine heart disease risk. Patients should ask their doctors about hs-CRP specifically. With hs-CRP test results, a level above three raises major concern because it means a person’s risk for heart attack is at least doubled. One to three merits some concern, but is not serious. Below one is where we want all patients. Readings of 50 and above are possible, but we generally attribute a level higher than 10 to an infection or other source of inflammation somewhere in the body, not arterial inflammation.

Q: How does the hs-CRP test compare to other indicators, such as cholesterol and stress tests?

A: The exercise stress test tells us when narrowed arteries cause a shortage of blood going to the heart. It is still a vital risk indicator. LDL cholesterol is important to watch because it can narrow and clog arteries. There are two types of LDL cholesterol, the bad kind and the really bad kind, which we call oxidized LDL cholesterol. The available cholesterol test does not differentiate between these two types; it only tells a person’s total LDL level. However, this bad, oxidized type, which hurts the arteries and speeds up plaque formation, has a direct correlation to CRP levels. Arteries can produce CRP directly at sites where there is cholesterol buildup. So, hs-CRP testing offers a window into how much of the especially bad cholesterol a person has in his or her blood.

Q: How often should CRP levels be tested?

A: There’s no cookbook solution. If someone comes in high and then works on lowering their CRP levels, I might re-check it in a month or two. But, if the initial level is low, I may not check it again for two-to-five years. It really depends on the patient and adoption of lifestyle changes or other treatments.

Q: Is arterial inflammation the only cause of high CRP?

A: Inflammation in the body due, for instance, to infection or a serious arthritic flare, can raise CRP. Before getting an hs- CRP test, patients should tell their doctors if they are experiencing health problems that can cause general inflammation, for example, joint problems or a respiratory infection. If tested while ill or injured, and hs-CRP comes back elevated, it’s important to get re-tested once healthy. But, pinpointing an alternative reason for a high hs-CRP reading doesn’t eliminate the increased risk for heart disease or the value of the hs-CRP test. Inflammation anywhere in the body makes the arteries vulnerable because the cells and substances in the body that drive inflammation are thrown into high gear. Inflammation itself fuels further inflammation.

Q: What can I do if my hs-CRP level is high?

A: 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.

Results

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

 Are There Ways to Lower Your CRP Levels Without Statins?

According to Dr. Mark Liponis in Ultralongevity, you can lower your CRP levels in the following ways.

• Consume small oily fish twice a week or start taking a high quality fish oil capsule(s)
• Get a full 1000 IUs of vitamin D
• 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
• Stay hydrated
• Watch your belly fat--women should keep it less than 30 inches, men under 40 inches.

According to Dr. Michael Roizen, in You Staying Young, you can lower your CRP levels in the following ways.

• Eat lots of fruit & vegetables high in antioxidants--kale, collards, Swiss chard and spinach are highest in this category.  See the ORAC (oxygen radical absorption scale) list of the antioxidant rankings in my green smoothie post.
• Garlic
• Omega-3 fatty acids (fatty fish/fish oil)
• 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)