Inflammation now predicts heart disease more strongly than cholesterol
3 hours ago
- #heart disease
- #inflammation
- #hs-CRP
- Chronic inflammation doubles the risk of heart disease and is now recognized as a standard modifiable risk factor (SMuRF) by the American College of Cardiology (ACC).
- The ACC recommends universal screening for hs-CRP (high-sensitivity C-reactive protein) via blood tests to assess inflammation alongside cholesterol.
- hs-CRP is a stronger predictor of heart disease than LDL cholesterol, especially in individuals on statins or those without traditional risk factors (SMuRF-less patients).
- Clinical trials show that statins, colchicine, and canakinumab can reduce cardiovascular events by lowering inflammation, while some anti-inflammatory drugs like methotrexate and TNF inhibitors show no benefit.
- Lifestyle interventions such as anti-inflammatory diets (Mediterranean, DASH), regular exercise, smoking cessation, and maintaining a healthy weight effectively lower hs-CRP and reduce risk.
- An ideal hs-CRP level is below 1 mg/L, while levels above 3 mg/L indicate high risk.
- Other biomarkers of inflammation (e.g., IL-6, fibrinogen) provide limited additional predictive value once hs-CRP is measured.
- Imaging biomarkers (CT, PET, MRI) can detect vascular inflammation but are not yet ready for routine clinical use.
- Bempedoic acid, a newer cholesterol-lowering drug, also reduces hs-CRP, but long-term outcomes are still under study.
- The ACC now recommends universal hs-CRP screening for both primary and secondary prevention of heart disease.
- Colchicine (0.5 mg/d) is FDA-approved for secondary prevention in stable ASCVD but should be avoided in patients with kidney or liver disease.
- Novel IL-6 inhibitors are being studied as potential future therapies for heart disease.