C-Reactive Protein and Heart Disease

Many people don’t realize this, but the only reason many of us are so concerned about our cholesterol levels is that to date, cholesterol has given us a “best guess” as to our risk for heart disease.

However, half of all people who suffer heart attacks have normal cholesterol levels.

Scientists still don’t know exactly what leads to a heart attack, but it’s beginning to look as though inflammation is one important piece of the puzzle.

The Research

Two recent studies have now confirmed that lowering levels of C-reactive protein (CRP) can reduce the risk of heart disease. One study, published in the January 6, 2005, issue of The New England Journal of Medicine (pp. 20-28), showed that heart disease patients have an increased risk for a heart attack and death when their levels of CRP were elevated, even when their LDL (“bad”) cholesterol was in the desirable range, below 70 mg/dl. A second study published in the same journal showed that patients with the biggest drop in CRP after treatment had the greatest reduction in the progression of arterial plaque buildup; some patients even had a reversal of buildup.

Drug companies funded both of these studies, and the reductions in CRP were primarily a result of patients taking statin drugs. However, lifestyle changes can also lower CRP levels.

Carbs and CRP

A low-carbohydrate approach to eating can be a safe and effective way to lower CRP levels for some individuals.

High levels of CRP are nearly three times more common in people who show signs of the metabolic syndrome than in people without signs. Research that appeared in the September 15, 2004, issue of the American Journal of Medicine (pp. 398-405) shows that people with the metabolic syndrome or diabetes experience greater decreases in CRP levels when following a low-carb approach than those on a high-carb, low-fat diet. Also, the low-carb diet yielded better CRP levels even in subjects who did not lose weight. The converse is also true: The more carbs you eat, the higher your CRP levels.

The message seems clear. Whether or not you take statin drugs, another way to keep CRP levels in check is to control your carbohydrate intake.

Invisible Inflammation

An elevated level of C-reactive protein (CRP), which is produced in the liver, is a marker for microscopic inflammation—swelling that occurs at the cellular level. You wouldn’t know you have a high CRP level unless you took a now widely available blood test to measure it. Emerging research suggests that CRP is an important predictor of heart disease.

However, because CRP is a marker of general inflammation, it may be unrelated to heart disease risk; repeat tests are always recommended.

Most physicians do not recommend routine CRP screening of the general public at this time. In addition to diet, other risk factors need to be evaluated such as blood pressure, cigarette smoking, physical activity and stress management. The American Heart Association and the Centers for Disease Control and Prevention recommend CRP screening for people with an intermediate risk—that is, a 10 percent to 20 percent chance—of developing coronary heart disease in the next 10 years.

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