An analysis of three large studies of people taking statins found that a blood test for inflammation levels was better than tests of cholesterol levels for predicting future heart attacks (Lancet, March 06, 2023). More than 30,000 participants in the PROMINENT, REDUCE-IT and STRENGTH studies were given CRP (c-reactive protein test that measures inflammation) and cholesterol tests, and the researchers found that CRP was a stronger predictor for risk of future cardiovascular events and deaths than the cholesterol assessment (LDL).
Why would tests of inflammation levels be useful in predicting heart attacks? An over-active immune system, using the same cells and chemicals that it uses to kill germs, can punch holes in the inner linings of arteries. Then that area bleeds and plaques start to form. Heart attacks are not caused by narrowed arteries; they occur when inflammation causes plaques to break off from arteries, followed by bleeding and then clotting that extends to block completely all flow of blood to a part of the heart muscle. The heart muscle then suffers a sudden complete lack of oxygen and that portion of the heart muscle dies, which is a heart attack. See Inflammation Can Help or Harm
Drugs That Reduce Inflammation Help to Prevent Heart Attacks
One of the reasons statins help to prevent heart attacks is that they reduce inflammation as well as lowering cholesterol (Curr Cardiol Rev, Aug 2017;13(3): 209–216). Similar results have been found with several other drugs. For example:
• Bempedoic acid is not a statin, but it blocks inflammation and markedly lowers LDL cholesterol by blocking cholesterol synthesis and reduces risk for heart attacks by 23 percent (NEJM, March 4, 2023).
• Canakinumab (Llaris), a drug that reduces inflammation but does not lower cholesterol, helps to prevent heart attacks and hospitalization and death from heart attacks (Circulation, 2019 Mar 5;139(10):1289-1299; Front Cardiovasc Med (Coronary Artery Disease), February 16, 2023;10).
• SGLT inhibitors, drugs presently approved to treat diabetes, also appear to help prevent heart disease and death from heart disease by blocking inflammation (Int J Mol Sci, Jun 4, 2021;22(11):5863).
• Drugs that lower triglycerides also help to prevent heart attacks (N Engl J Med, 2022; 387: 1923-1934; N Engl J Med, 2019; 380: 11-22).
• Colchicine has been around for years to treat people with gout by lowering uric acid, and may help to prevent heart attacks because it reduces inflammation (N Engl J Med, 2019; 381: 2497-2505).
I believe that everyone should follow the anti-inflammatory lifestyle rules that help to prevent heart attacks, strokes, diabetes and many other diseases:
• try to exercise every day
• avoid red meat, processed meat, sugar-added foods, sugared drinks including fruit juices, and fried foods
• eat large amounts of fruits, vegetables and seeds
• lose excess body fat, particularly in the belly
• keep blood levels of hydroxy vitamin D above 30 ng/dL
• work to control high blood pressure, high cholesterol, and diabetes or pre-diabetes
• restrict or avoid alcohol
• avoid smoking and second-hand smoke
• avoid chronic exposure to excess sunlight
• avoid exposure to X rays and other sources of radiation, and exposure to harmful chemicals such as certain insecticides, herbicides and industrial chemicals
• treat chronic infections anywhere in the body