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Inflammation May Impair Heart as Much As Cholesterol

By Rob Stein
Washington Post Staff Writer
Thursday, January 6, 2005; Page A01

Damping down inflammation in the body appears to be just as important for fighting heart disease as lowering cholesterol, according to a pair of new studies that provide the first direct evidence that curbing inflammation can independently protect the heart.

Patients who reduced inflammation were significantly less likely to have their heart disease get worse or to die from a heart attack, even if their cholesterol levels were already low, the studies found.

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The results suggest that doctors should consider routinely monitoring inflammation in the same way they test cholesterol and take steps to reduce inflammation in patients with high levels, especially in those already at high risk, the researchers said.

The same steps that lower cholesterol -- a healthful diet, exercise, weight loss, quitting smoking, and cholesterol-lowering statin drugs -- can help reduce inflammation. In addition, researchers are studying new drugs that may specifically target inflammation.

"For the first time, we have hard clinical evidence that lowering inflammation lowers the risk of heart attack and stroke and cardiovascular disease," said Paul M. Ridker, a cardiologist at Brigham and Women's Hospital in Boston, who led one of the studies being published in today's New England Journal of Medicine. "The magnitude of the benefit is at least as large as the magnitude of the benefit from cholesterol reduction. This is a radical change in our thinking about heart disease prevention."

For years, doctors have thought coronary artery disease occurs primarily when high cholesterol causes fatty buildups called plaques inside the arteries that supply blood to the heart, like clogging a drain. The theory holds that arteries slowly narrow and eventually get blocked, often by a blood clot, causing a heart attack.

But in recent years evidence has accumulated that inflammation, a usually beneficial response by the immune system for fighting off infections and healing injuries, also plays a key role. Too much inflammation, perhaps from being overweight, having high cholesterol or suffering from a chronic low-level infection, appears to damage the lining of artery walls and contribute to the formation and rupture of plaques.

No one knows exactly how many Americans suffer from excess inflammation, which often produces no symptoms, but doctors can detect it by testing blood levels of a protein called C-reactive protein (CRP), which goes up and down as inflammation rises and falls. Some evidence suggests CRP may damage the lining of artery walls directly.

Other researchers called for more study before recommending routine testing and treatment of inflammation based on the new findings, but said the research provides powerful support for the new way of thinking about heart disease -- the nation's leading killer.

"These are very important findings -- they provide further evidence of the importance of inflammation in establishing risk in patients with known coronary heart disease," said Sidney Smith, of the University of North Carolina at Chapel Hill, speaking for the American Heart Association.

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