Articles
Your Health Alert
Week 7
Tuesday, December 2nd,, 2008
Daily Camera, Boulder, CO
Fire in the Artery
A heart attack or stroke is just as much about inflammation as it is about cholesterol. It is inflammation that causes cholesterol to form plaque in your arteries. It is inflammation that causes the fibrous cap covering the plaque in your arteries to rupture and cause a heart attack. Various types of inflammation can be seen in every part of the body. It is seen in an arthritic knee or low back, a pimple on the skin, or an infection like a sore throat. It is also seen in inflamed arteries, but arterial inflammation can be treated.
So I check each patient for arterial inflammation by looking for markers of inflammation in the blood and urine. The best indicator is a blood test called Lp-PLA2, which is an enzyme that promotes inflammation within the arteries and leads to rupture-prone plaque. An elevated Lp-PLA2 doubles your risk for cardiovascular disease and is a better predictor of stroke risk than cholesterol. In fact, having an elevated Lp-PLA2 and a high blood pressure gives you six times the risk of having a stroke.
A different, and more commonly used marker of inflammation is the High sensitivity C-Reactive Protein (hs-CRP). Even in patients without any other warning signs of cardiovascular disease, high hs-CRP levels are associated with a 4 times increased risk of developing atherosclerosis. The JUPITER study, just released two weeks ago, looked at people with normal cholesterol but an elevated hs-CRP. Those given a placebo had twice as many heart attacks and strokes as those who took the drug Crestor.
Fibrinogen is mainly used for blood clotting, but is also a reactant which can be elevated in a variety of inflammatory conditions, including cardiovascular disease. Levels can be elevated in tobacco use, hormone and birth control use, excess weight, sedentary lifestyle, stress and diabetes. We always look for it because it can signal a very serious problem.
Progression of calcified plaque, as measured by an EBT heart scan, might be considered the ultimate marker of inflammation. Progression of calcified plaque is associated with as much as a 17 fold increased risk of heart attack compared to patients with stable calcified plaque score.
Just like last week on cholesterol, I have my own cutoff levels for normal on these markers of inflammation. They are Lp-PLA2 150, hs-CRP 1.0, Fibrinogen 300, urine MA/Cr 4.0 male and 7.0 female, GGT 15, Uric acid 7. I check all my patients for markers of inflammation because it is just as predictive of a heart attack or stroke as is cholesterol. If these numbers are abnormal, I will treat them aggressively because that is what is needed to prevent cardiovascular disease.
Joe Turnbow, M.D.
Copyright 2008, Heart Attack Prevention Strategies P.C. All rights reserved.