“Create in me a clean heart . . .”
~ Psalm 51:10
Heart disease is the leading cause of death in the US. Persons at the highest risk of dying from cardiovascular disease (CVD) include:
- Those who are overweight or obese especially those with central adiposity
- Those with a family history of heart disease or heart attack
- People over 55 years of age.
Yet, of these persons who die from cardiovascular disease, approximately half had no evidence of hyperlipidemia, a major risk factor for heart disease and routinely screened via blood test; and an additional 15 - 20% had none of the traditional heart risk factors. This suggests to make an impact on this cause of death there’s a need to better identify who is at risk.
Lifestyle risk factors for CVD are well established. Additionally, there are numerous biomarkers associated with CVD identification. A biomarker is a measurable substance whose presence indicates something exists. A reliable biomarker that could suggest the future and be detected via routine blood work could better indicate a person’s health status. Such a biomarker could support better medical decision-making and potentially the prevention of undesirable outcomes.
One biomarker is an indication of inflammation. Inflammation is a normal part of the body’s immune response to illness or injury. A cut or impalement is attacked by the immune system’s white blood cells and chemical responses to stop potential germs that could threaten individual health. Similarly, the cardiovascular system responds to injuries with its own inflammation response. Cardiovascular risk factors such as smoking, high blood pressure and bad cholesterol can change the environment inside arteries and blood vessels resulting in micro-injuries to the arteries and vessels lining. The cardiovascular system tries to smooth over these injuries with fat deposits. As exposure to a toxic environment inside the arteries continues to occurs, repeated layering of fat over injuries narrows arteries and increases opportunities for arterial blockage and disruption or blood flow.
Although a normal response to arterial injury, the body knows something is going on that’s not normal. Cardiovascular inflammation begins to rise and the body attempts to wall these artery injuries with plaque. Plaque creates another potential problem in an inflammatory environment as sometimes the plaque wall fails, triggering a blood clot formation in the blood stream. Some of these clots find their way to coronary arteries causing a myocardial infarction (heart attack) or to the brain causing an ischemic stroke.
While the cardiovascular immune system is responding to an injury, biomarkers of inflammation begin to show up in the blood. Research has found that persons with cardiovascular risk factors tend to have elevated inflammation biomarkers. Over time we have learned that even persons without risk factors may also have elevated blood levels of inflammatory biomarkers. The higher the inflammation, the greater the risk of having a heart attack of stroke — with or without additional risk factors.
C-reactive protein (CRP) is one biomarker that is easily measured and closely associated with cardiovascular inflammation and atherosclerosis. There are currently two tests for CRP:
- Standard CRP blood test measures C-reactive protein / inflammation in the 10 - 1,000 mg/dL range.
- The high sensitivity CRP (hs-CRP) measures C-reactive protein / inflammation in the 0.5 to 10 mg/L range.
The hs-CRP test accurately measures low but persistent levels of inflammation and thus helps predict a person's risk of developing problematic cardiovascular disease. The earlier the biomarkers are identified the earlier measures can be initiated to prevent a cardiovascular or ischemic event.
According to the American Heart Association (AHA) research does not support the entire adult population screening via hs-CRP for purposes of cardiovascular risk assessment at this time. Despite this the goal remains the same: lower individual risk for arterial inflammation in all people. The good news: individual lifestyle can make a difference. Controlling risk factors that impact the arterial environment is critical and may include the AHA’s “Life’s Simple 7”:
- Manage blood pressure by medication(s), healthy eating, weight loss, adequate sleep, and not smoking.
- Control cholesterol and minimize low density lipoproteins (bad) cholesterol via medication(s), healthy eating, physical activity and avoiding saturated fats.
- Minimize high blood sugar via medication(s), healthy eating, being active, monitoring blood glucose.
- Eat better to support a low fat and low sodium meal plan. When fats are consumed, select healthy fats — monounsaturated and unsaturated fats — and avoid saturated fats.
- Losing a little weight reduces the burden on the heart. Weight that centers in the belly region tends to be visceral fat (it’s actually embedded around the vital organs). It is associated with elevating cardiovascular inflammation.
- Stop smoking is the absolute best thing you can do for your health — no debate. When you quit smoking you can lower cardiovascular disease risk by half!
- Get active. The easiest way to begin an activity program is by avoiding inactivity every day — just move! As movement becomes part of your lifestyle you can expand the movement to more physically intense activities. You will love the difference!
Pharmaceutical support for individuals determined to have an elevated cardiovascular risk may include statins: cholesterol-lowering drug that reduces cholesterol and supports a reduction in arterial inflammation.
If you’re concerned about your cardiovascular risk, have a discussion with your health care provider. When a blood test for inflammatory biomarkers are considered, an hs-CRP (high sensitivity C-Reactive Protein) if the blood test of choice.