Heart disease: Mainstream finally acknowledges heart disease risk factor

No one yelled, 'Stop the presses!' No urgent 'breaking news' bulletins came across the newswires. Nevertheless, a new era dawned recently when the medical mainstream finally gave its official stamp of approval to a cardiovascular risk factor that HSI members have known about for years: C-reactive protein (CRP).

CRP is produced by the liver in response to inflammation, and is considered by many to be a more reliable marker for cardiovascular complications than cholesterol levels. In a nutshell: Atherosclerosis (narrowing of the arteries) requires inflammation to take place. If CRP is elevated, the stage is set for potential heart problems.

So why the sudden acknowledgement of CRP's dangers? Simple: Two recent studies indicate that statin drugs may lower CRP.

See? All that was needed was a little motivation (like increased sales of the medical mainstream's most beloved product) to recognise the importance of CRP.

New England connection

The New England Journal of Medicine (NEJM) published both of the new CRP studies in the US in January; one from the Cleveland Clinic, and one from Brigham and Women's Hospital and Harvard Medical School.

In the first, researchers led by the Cleveland Clinic drew their conclusions from a trial in which about 500 patients with coronary disease were given either 80 mg of Lipitor per day or 40 mg of Pravachol per day for 18 months. (According to the New York Times, Pfizer - the maker of Lipitor - sponsored the original study which tested these two statin drugs head-to-head...if you can call a 100 percent difference in dosage 'head-to-head.')

Using an ultrasonography technique on each subject in the study, the Cleveland team found that atherosclerosis progression was reduced, while CRP levels dropped by 36 percent in the high dose Lipitor group and five percent in the low dose group. (By the way: Three of the ten researchers on this new study were affiliated with Pfizer.)

In a press release from the Cleveland Clinic, lead researcher Dr Steven Nissen, stated: 'Until now we did not have evidence that targeting CRP could reduce disease burden.'

Actually, we did have evidence. We've had it for years. It just wasn't tied in with statin use.

If Dr. Nissen will check his back issues of the New England Journal of Medicine (Vol. 347, No. 20, 11/14/02), he'll find a study that followed more than 27,000 women for eight years to compare CRP and LDL in the prediction of cardiovascular events.

Researchers found that subjects with the highest CRP levels were more than twice as likely to experience an adverse cardiovascular event than those with the lowest levels of CRP. When subjects with high CRP levels were compared to subjects with high LDL cholesterol, the data suggested that the CRP reading is a more reliable predictor of CV events. Furthermore, subjects with high CRP were found to be at higher risk, EVEN WHEN THEIR LDL WAS LOW.

This is completely contrary, of course, to what conventional mainstream thinking on cholesterol would have us believe.

Pfizer-free

The other recent CRP study that appeared in the January NEJM also found statins to be effective in lowering CRP among more than 3,700 subjects with acute coronary syndromes. But here's the comment that jumped out at me from the conclusions of this study: 'Patients who have low CRP levels after statin therapy have better clinical outcomes than those with higher CRP levels, regardless of the resultant level of LDL cholesterol.'

So, REGARDLESS of what the LDL may be, lower CRP is associated with a better clinical outcome. There's your headline right there. Not only is CRP becoming a star, but it appears that the mainstream's old trooper - LDL cholesterol - may be getting shoved off the stage.

Of course the REAL star being promoted here (as usual) is statins. But is statin therapy necessary to lower CRP? Absolutely not.

In a past e-alert, I told you about a study that examined the dietary and medical records of more than 3,900 men and women to assess the association between dietary fibre intake and CRP levels.

Comparing subjects who had the highest fibre intake with those who had the lowest, researchers found that CRP levels were lowest among subjects with fibre-rich diets. How fibre intake affects inflammation is still poorly understood, but previous studies have shown that soluble fibre intake may have a preventive effect against heart disease. Soluble fibre sources include fruits, vegetables, nuts, seeds, legumes, oats and barley.

And there's another common nutrient that can help lower CRP. In a previous e-alert, I told you about research reported in the Journal of the American College of Nutrition in which vitamin C cut CRP levels by nearly 25 percent.

As you might guess, no Pfizer researchers were involved with either of these studies.