By David Blyweiss, M.D.
Most of my patients are familiar with many of the common risk factors for heart disease—high cholesterol, elevated blood pressure, and even homocysteine. But one of the most critical risk factors is one that slides under the radar of patients and their doctors: inflammation.
Inflammation is the body’s response to injury. When you catch a cold or cut your finger, your immune system kicks in, triggering a chain of events called the “inflammatory cascade” that aids in healing what ails you.
Familiar signs that your immune system is being called into action include fever, pain and swelling. When the problem has resolved itself, the immune system stops sending these inflammatory signals. But problems occur when this inflammatory response doesn’t shut down. This leads to chronic low-level inflammation that can cause many seemingly unrelated diseases, including heart disease, stroke, cancer, diabetes, osteoporosis, Alzheimer’s and autoimmune diseases like rheumatoid arthritis and psoriasis.
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One way to tell how much inflammation you have is by measuring C-reactive protein (CRP). CRP is a strong predictor of a first-time heart attack, even when cholesterol levels are normal. One study of 1,086 men by researchers at Harvard Medical School found that those with the highest levels of CRP were three times more likely to suffer a heart attack. Other research by the Pacific Health Research Institute in Hawaii found that men with high CRP levels are twice more likely to suffer a stroke than those with normal CRP levels.
But as important as CRP seems to be, it turns out that it isn’t the only marker of inflammation. Researchers have found another marker that may be even more critical because it can predict both heart disease and stroke with an even higher degree of accuracy. It might also be directly implicated in atherosclerosis.
A newly-released analysis of more than 30 studies has confirmed that an inflammatory enzyme called lipoprotein-associated phospholipase A2 can signal a significant risk for coronary heart disease—more than cholesterol and even CRP levels.
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Lp-PLA2 attaches itself to LDL cholesterol particles and contributes to atherosclerotic plaque. It also produces signals within the plaque that promotes inflammation. High levels trigger a cascade of inflammatory events that can affect people who don’t have any of the classic risk factors for heart disease. How dangerous is elevated Lp-PLA2? It turns out that people with normal LDL levels have twice the risk for a heart attack if they have high levels of Lp-PLA2 in their blood. And if Lp-PLA2 and CRP are both elevated, the risk of a heart attack triples.
The new analysis, which involved about 80,000 people, confirmed the importance of having your Lp-PLA2 levels measured to determine your risk of suffering a heart attack or ischemic stroke, even if you don’t have any of the classic risk factors. The test, which is relatively inexpensive, is called the PLAC Test and it’s the only blood test cleared by the FDA for predicting the risk of coronary heart disease and ischemic stroke associated with atherosclerosis.
While there is still a lot that the medical establishment needs to learn about the role Lp-PLA2 plays in heart disease, stroke and other chronic diseases, I strongly recommend asking your doctor to check your levels. While your levels can range from 120 nanograms per milliliter (ng/mL) to 376 ng/mL or more, lower is better. Typically, women will have levels around 174 ng/mL and men average about 251 ng/mL. If your levels are above these averages, it’s smart to take steps to lower your Lp-PLA2 levels and, as a result, overall inflammation.
Studies show that physical activity can help keep a lid on both CRP and Lp-PLA2. According to researchers at the Royal Free and University College London Medical School, regular exercise changes body composition. This, in turn, has a beneficial affect on Lp-PLA2 levels.
What you eat can also play an important role. Maximize your intake of fruits and vegetables while you minimize your consumption of red meat and refined foods. You can also thwart these inflammatory markers with supplements. Fish oil (3,000 mg/day), boswellia (150 mg. of a standardized supplement 3x day) and tumeric (250 to 500 mg. of a standardized extract 3x day) are all potent anti-inflammatories and should be incorporated into a healthy lifestyle each and every day. You heart will certainly thank you for it.
References:
Rosenson R, “Lp-PLA2 and risk of atherosclerotic vascular disease” Lancet 2010; 375: 1498-1500.
The Lp-PLA2 Studies Collaboration. Lipoprotein-associated phospholipase A2 and risk of coronary disease, stroke, and mortality: collaborative analysis of 32 prospective studies. The Lancet; 375: 1536-1544.
Wootton PT. Lipoprotein-associated phospholipase A2 A379V variant is associated with body composition changes in response to exercise training. Nutrition, Metabolism and Cardiovascular Disease. 2007;17:24-31
