The New Heart Disease Threat

Published: January 11, 2005

The evidence has gotten much stronger that a substance known as C-reactive protein may be every bit as important as cholesterol in the diagnosis and treatment of heart disease. Back in 2002, a thought-provoking study found that a blood test for C-reactive protein, called CRP, was actually better than the standard cholesterol test at predicting the risk of a heart attack or a stroke. Now two studies published in The New England Journal of Medicine have shown that drugs that reduce the levels of that protein in patients with severe heart disease can slow the progression of atherosclerosis and prevent heart attacks and cardiac-related deaths.

Although the studies came laced with caveats, their cumulative impact suggests that cardiology is in the midst of a revolutionary shift in understanding the causes of heart disease. After years of focusing on the role of cholesterol in clogging arteries, researchers now recognize C-reactive protein, a measure of inflammation in artery walls and elsewhere, as a prime risk factor in its own right.

The key study published last week found that heart disease patients who were given high doses of a cholesterol-lowering statin drug also experienced a drop in CRP levels and in heart attacks. Thus the high-dose statin packed a double wallop.

These findings apply only to patients already suffering from severe heart disease. A separate clinical trial will seek to determine whether lowering C-reactive protein can reduce heart attacks in healthy patients with normal cholesterol levels but above-average levels of C-reactive protein. Nearly half of all people who suffer heart attacks have normal cholesterol levels, so it is critical to devise tests and treatments to reduce their risk.

Even before the final clinical results are in, it would seem prudent for all overweight couch potatoes who think they are safe because their cholesterol levels are low to get their C-reactive protein levels tested. If their CRP levels are high, they may be spurred to lose weight, exercise and stop smoking to bring down those protein levels. High doses of statins, with their risk of side effects, would presumably be a last resort.