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Issue 133 Item 15 Inflammation Triggers Heart Attacks

The evidence is overwhelming that inflammation is a central factor in cardiovascular disease, by far the world’s biggest killer. Despite healthy cholesterol levels, new research shows many people are at high risk of heart attacks because of painless inflammation in the bloodstream.

The inflammation comes from many sources and triggers heart attacks by weakening the walls of blood vessels, making fatty buildups burst. A large study published Thursday concludes it is twice as likely as high cholesterol to trigger heart attacks.

Over the past five years, research by Dr. Paul Ridker of Boston’s Brigham and Women’s Hospital has built the case for the "inflammation hypothesis." With his latest study, many believe the evidence is overwhelming that inflammation is a central factor in cardiovascular disease, by far the world’s biggest killer.

"I don’t think it’s a hypothesis anymore. It’s proven," said Dr. Eric Topol, chief of cardiology at the Cleveland Clinic. Inflammation can be measured with a test that checks for C-reactive protein, or CRP, a chemical necessary for fighting injury and infection. The test typically costs between $25 and $50.

Diet and exercise can lower CRP dramatically. Cholesterol-lowering drugs called statins also reduce CRP, as do aspirin and some other medicines.

Doctors believe the condition often begins when the fatty buildups that line the blood vessels become inflamed as white blood cells invade in a misguided defense attempt. Fat cells are also known to turn out these inflammatory proteins. Other possible triggers include high blood pressure, smoking and lingering infections, such as chronic gum disease.