A patient asks: What is the role of inflammation in heart disease? What causes it, and how do you treat it?

A doctor answers: Current theory is that inflammation within the walls of the arteries is the underlying cause of plaque and blockage in those arteries.

Inflammation (from the Latin īnflammō, “I ignite, set alight”) is the medical term for the body’s reaction to a harmful stimulus. When I was in medical school, I was taught that the four cardinal signs of inflammation were: rubor (redness), turgor (swelling), calor (heat or warmth) and dolor (pain).

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A common example might be a bad skin infection such as an abscess, or a cellulitus, where the harmful stimulus is a bacterial pathogen. Another well-known example is a swollen, painful great toe in a patient with gout, where the harmful stimulus is uric acid crystals in the joint.

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At a cellular level, inflammation involves infiltration of white blood cells (leukocytes, monocytes, macrophages) into the tissue where the harmful stimulus resides. These white blood cells try to fight and remove the offending stimulus by releasing toxic substances to kill bacteria, and then eating the debris.

Within arteries, the harmful stimulus is most commonly excess cholesterol. If your blood LDL cholesterol level is high, more of it enters the wall of your arteries than can be removed by the reverse transport protein HDL, and so cholesterol piles up.

The white blood cells react to it as if it were a foreign invader: they attack it and eat it. In the process of doing this, the wall of the artery becomes swollen with thousands of stuffed white blood cells, like pus in a boil or abscess. These micro-abscesses can rupture or burst through the inside lining of the artery, allowing the “pus” to drain.

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However, unlike an abscess or boil, which drains out of the body, these are draining into the bloodstream, and the body’s reaction is to try to seal off the invader. It does this by forming a blood clot at the site of the micro-abscess rupture. If this is in one of your coronary arteries, the result is a coronary thrombosis, or heart attack.

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Regarding “How do you treat it?”: Right now, our strategy is to lower the LDL cholesterol, and prevent the inflammation in the first place. Also, we aim to prevent a blood clot or coronary thrombosis by thinning the blood with aspirin.

So after hearing about this — how do you find out if you’re having inflammation? The answer is you need to measure your C-reactive protein (or CRP).

This substance is found in the bloodstream, and the concentration there reflects the ongoing level of inflammation in your body. If it’s very low — like than less than 1.0 — that’s an excellent sign, and indicates a very low likelihood of having a heart attack or stroke in the next ten years (as factored into the Reynold’s Risk Score — age, sex, cholesterol level, and CRP). I measure that in my patients to see whether they’re going to have a heart attack.

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If the CRP is at a high risk level — greater than 3 — I make an extra effort to bring the LDL cholesterol down to 70 or less. And when this is done with a statin and brings the LDL down, it usually causes the CRP to fall.

Regardless of statin therapy, lifestyle changes are also key for reducing inflammation. Exercise (walk more, take the stairs), a diet rich in fruit and vegetables, olive oil, and fatty fish (salmon, sardines, etc). are not only anti-inflammatory, they’ll help you lose weight. This can’t be under-emphasized: Excess fat, in and of itself, is an inflammation factor.

Bringing down inflammation will not only benefit your heart — but also help protect your mind, your joints, even your face (less wrinkles). So get tested, and take steps to reduce your inflammation and lower your disease risk.