cardiac
HEALTH ON TIME
TM
FALL 2013
inflammation at the heart of the matter INFLAMMATION OF THE ARTERIES MAY INDICATE FUTURE HEART ATTACKS AND STROKES
R
ecent evidence suggests that inflammation of the arteries may be an important indicator of future heart attacks and strokes. Researchers have found that blood levels of a protein called C-reactive protein (CRP), which indicates underlying levels of inflammation, are found to be elevated many years before a first heart attack or stroke. According to several studies, the one-third of subjects with the highest levels of C-reactive protein had twice the risk for coronary heart disease and stroke compared to the bottom one-third with the lowest levels of the protein.
Inflammation may lead to narrowing of the coronary arteries, which may increase your risk for heart disease. Inflammation occurs when the body responds to injury. What causes inflammation of the arteries is not known. But infection—possibly caused by bacteria or a virus—might contribute to or even start the narrowing process. Other possible factors that may cause an inflammatory response in the body are: • smoking • high blood pressure • diabetes • high cholesterol levels These risk factors may cause inflammation of the coronary and carotid arteries, which may lead to narrowing of these vessels. This may in turn increase your risk for coronary heart disease and stroke. The process that triggers the body’s inflammatory response needs to be investigated in large randomized clinical trials. There are research projects underway at the moment to help explain what triggers the body’s inflammatory response to each risk factor for coronary heart disease and how the body responds to damage and stress of blood vessels. There is
T H E I N F L A M M AT O RY T H E O RY Inflammation is part of the body’s healing of infections, but new research suggests it also may cause heart disease when the immune system mistakes certain fats for germs and attacks them.
Coronary artery
1
LDLs — molecules carrying cholesterol — accumulate in the artery, change chemically and attach to artery wall.
2
Immune system is alerted and sends white blood cells, which normally ingest germs and send out chemicals to kill them.
3
White blood cells swallow LDLs, turn into foam cells filled with fatty LDL droplets and form plaques on artery walls.
New LDLs
White blood cell
Plaque
Foam cell
4
Foam cells fatten and release free radicals, creating more LDLs; immune system sends more white blood cells.
5
Ongoing inflammation can make plaque rupture and release debris that can form a blood clot and block the artery.
New LDLs
Rupture
Source: American Source: Scientific Scientific American Graphic: Graphic: Hayoun HaynounPark Parkand andTerance TerenceHoran, Horan,Chicago ChicagoTribune/KRT Tribune/KRT
strong evidence that CRP should be routinely considered along with standard cholesterol evaluation for those at immediate risk—for example, someone considered to have a 10 to 20 percent risk for heart attack in the next 10 years based on his or her health status. For the rest of us, the American Heart Association does not recommend CRP testing—just regular cholesterol testing and blood pressure screening.
Coronary Calcium Scans This easy, 15-minute test is up to 10 times more accurate at predicting your heart attack risk than traditional diagnostic methods. To schedule, call 706-721-9729 or visit gru.edu/cardio.
how does inflammation affect the heart?
“C
hronic inflammation may contribute to the formation of plaque in the walls of blood vessels,” says Sheldon Litwin, MD, a cardiologist at Georgia Regents Cardiovascular Center. “Perhaps more importantly, inflamed plaques are more likely to become unstable and to become the site of clot formation. This is the situation
that most commonly leads to a heart attack or stroke.” People with poor health habits, especially those who are obese or sedentary, tend to have higher levels of inflammation. “If you are overweight, particularly in the mid-section, you are at increased risk of having high blood pressure, insulin resistance, or high triglycerides that are caused in part by inflammation,” says Dr. Litwin.
Take Heart!
Georgia Regents University 1120 15th St., AD 1114 Augusta, GA 30912
NONPROFIT U.S. POSTAGE PAID GEORGIA REGENTS UNIVERSITY GRU-006
Fortunately, the following lifestyle changes can help reduce or prevent chronic inflammation: •E at a healthy diet rich in fruits and vegetables. Eliminate trans fats and reduce saturated fats found in red meats, butter and other products. •E xercise regularly.
•R educe stress and get plenty of sleep. •L ose weight, if needed. •D on’t smoke and avoid secondhand smoke. Use of certain medications, particularly statins, may help to prevent heart attack or stroke in patients with elevated inflammatory markers, even when cholesterol levels are normal. “Good health habits can reduce inflammation and possibly lower your risk for heart disease and stroke,” Dr. Litwin says.
For more information, please visit gru.edu/cardio.