May
01
2004

Chronic Inflammation Causes Cancer, Heart Attacks And More

When the Time Magazine devotes 7 full pages in the March 22, 2004 issue to the topic of inflammation as the source of most of the diseases of the Western World, you know that something important is happening in medicine. Christine Gorman and Alice Park have summarized some of the groundbreaking research of the past few years in this article. I will report about this article here, but also include direct links regarding some of the relevant research the authors have mentioned including some of the key links regarding the metabolic syndrome, which was not mentioned in the article.

Since the beginning of the obesity wave in North America it has become obvious that a cluster of diseases such as heart attacks, strokes, Alzheimer disease, cancer of the colon, multiple sclerosis, arthritis and others have also become more frequent. Dr. Paul Ridker, a cardiologist at Brigham and Women’s Hospital, was one of the pioneers of investigating inflammation as a possible cause and the common denominator of these diverse illnesses. He noticed that certain patients got heart attacks although their blood LDL cholesterol levels (the “bad” cholesterol) were normal. The theory at that time was that all patients who would develop heart attacks would come from a high-risk group of patients with elevated LDL cholesterol. The problem was that 50% of patients with heart attacks had normal LDL cholesterol levels. Dr. Ridker suspected that the C-reactive protein (CRP), which is found to be elevated in the blood of rheumatoid patients, would be somehow involved in the disease process of hardening of the arteries before a heart attack would occur. CRP is produced by the liver cells and by the lining cells of arteries in response to a general inflammatory reaction in the body. Examples of this would be rheumatoid arthritis patients and patients with autoimmune diseases, where CRP levels can be readily measured with a blood test. Dr. Ridker found that there was a very good correlation between the CRP level and the degree of inflammation as well as the risk for developing heart attacks and strokes. Further investigation by others confirmed that CRP levels were perhaps more important than LDL levels in predicting impending heart attacks. This is so, because CRP is the body’s substance in the blood stream that would be responsible for breaking up LDL containing deposits (plaques) in the walls of the arteries, which leads to heart attacks in the heart and to strokes in the brain.

Chronic Inflammation Causes Cancer, Heart Attacks And More

Chronic Inflammation Causes Cancer, Heart Attacks And More

Other investigators found that CRP was only one link in a complex chain of events that includes inflammatory substances (cytokines) from the fat cells as well as insulin and insulin-like growth factors from the metabolic syndrome. Leptins are also a factor as has been discussed under this link.
Dr. Steve Shoelsen from the Joslin Diabetes Center in Boston has developed a mouse model for the metabolic syndrome. These mice will produce huge amounts of inflammatory substances in their fatty tissue in response to any inflammatory process that is started in them. Anti-inflammatory drugs such as the statins or metformin, it is hoped, will be shown conclusively to dampen the inflammatory process and prevent heart attacks, strokes and diabetes as well as cancer, Alzheimers disease and arthritis. Heart disease has already been shown to be improved by anti-inflammatory drugs. Asthma is an inflammatory disease of the small bronchial tubes, which can be stabilized with the anti-inflammatory drug Avastin.

What can we do as consumers to prevent some of those life-threatening diseases? By reducing our weight through calorie restriction on a low-glycemic diet we can help to reduce the insulin-like hormone substances of the fatty tissue. Regular exercise of at least 30 minutes of a brisk walk daily or the equivalent of other sports activities will half our risk for colon cancer and many other cancers. A diet rich in fruits and vegetables as well as fish and fish oils will reduce the amount of free radicals in our system cutting down on the circulating inflammatory substances. This prolongs life, prevents all of the major diseases of modern civilization and leads to longevity as the study of the Okinawa diet has shown.

Based on an article in the Time Magazine, March 22, 2004 edition, page 54 to 60.

Here is a chapter on arteriosclerosis from the Net Health Book, which explains inflammatory changes of the arterial wall:

http://nethealthbook.com/cardiovascular-disease/heart-disease/atherosclerosis-the-missing-link-between-strokes-and-heart-attacks/

Last edited October 26, 2014

Feb
01
2003

CRP Test Better Than Cholesterol Test

At the 75th Annual Scientific sessions of the American Heart Association in Chicago several presentations centered around the use of the C-reactive protein test to evaluate risks for heart attacks, strokes and the risk of restenosing after doing a cardiac procedure to reopen stenosed coronary arteries.

I have previously reported about the use of the C-reactive protein (CRP) test in a review regarding Dr. Paul Ridker’s study in the New England Journal of Medicine.

This study is ongoing and is known under the name “Women’s Health Study”. He followed a large group of women and found that an increase of the CRP was closely associated with heart attacks. Other investigators found now that an increase of CRP is closely linked with obesity, with the metabolic syndrome (also known under “insulin resistance”) and hormone replacement therapy.

CRP Test Better Than Cholesterol Test

CRP Test Better Than Cholesterol Test

There appears to be a pivotal shift among cardiologists in that it is now clear that inflammation seems to be at the center of the process of hardening of the arteries, not just in a few cases, but in everybody who has heart disease.  Below I  summarized some of the features of CRP in a table.

C-reactive protein (CRP) and risk for heart disease
Facts: Comments:
CRP is produced by the endothelial cells that line the arteries CRP is intimately involved with arteriosclerosis. It has been identified as the culprit, which produces hardening of the arteries together with LDL cholesterol
CRP interferes with nitric oxide release from the endothelial cells, which is required for normal function this leads to a dysfunction of the lining of the arteries, atheromatous plaque formation and it stimulates scavenger cells, called macrophages, to take up LDL. CRP also causes plaque destabilization and clotting
these factors elevate CRP: obesity, the metabolic syndrome, hormone replacement in menopause with artificial hormones, but NOT with bio-identical hormones
these factors lower CRP: low carbohydrate diet, exercise, statins, rosiglitazone (Avandia), lowering of insulin

There will be a lot of information coming out in the next few years. Two major trials have been started where patients with a normal cholesterol, but an abnormally high CRP, will be followed along.

The JUPITER trial will look at the effect of treating these patients with rosuvastatin (brand name: Crestor). About 15,000 patients will be enrolled in this trial and followed for about 4 years. The Canadian 4R trial (Risk Reduction with Ramipril in patients with high CRP) uses ramipril (brand name: Altace) for 12 weeks to see whether it reduces CRP levels. Much more research is needed, but the doctors already know enough about CRP to state that it is a major player when it comes to hardening of arteries. They also know that LDL cholesterol is not outdated, as both LDL cholesterol and CRP play important roles in this process.

Based on a cardiology update in the Medical Post, Dec. 31, 2002, page 17 to 19.

Comments on Dec. 10, 2012: The 4 R Canadian study showed a tendency towards a lowering of CRP with Ramipril, but it was statistically not significant due to numbers that were too low and the observation period was not long enough. The Jupiter trial had to be abandoned after two years as there was concern of diabetes being caused by Crestor and because the effect of prevention of heart attacks was not seen early enough (the number of treatments required before a beneficial effect could be seen was too high). Here is a review why  rosuvastatin (brand name: Crestor) should be approached with caution.

Here are other links to related topics that won’t have serious side-effects:

Heart disease: http://www.nethealthbook.com/articles/cardiovasculardisease_heartdisease.php

Two things will lead to a normal weight (as you likely have heard before):

Proper nutrition…http://www.nethealthbook.com/articles/nutrition.php

…and proper exercise (fitness): http://www.nethealthbook.com/articles/fitness.php

Last edited December 10, 2012