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February 7, 2005

Elevated C-Reactive Protein Best Predictor of Heart Disease
Inflamed passion might be a good thing on Valentine’s Day — but chronic inflammation could put your heart out of commission for good.Inflammation is measured by blood levels of C-reactive protein (CRP) — a risk marker that’s gaining recognition as one of the most accurate predictors of future cardiovascular disease, as accurate (if not more) a diagnostic as your cholesterol count.What is inflammation? Inflammation is an immune response to infection or injury.Externally we recognize inflammation as redness, increased temperature and swelling — and in proper proportion it serves as part of the cycle of healing.The symptoms are evidence of immune cell activity working to break down injured and dying tissues so that new, healthy ones can replace them.But certain factors can force this delicate balance out of whack, leading — literally — to inflammatory overkill that over time can come to damage otherwise healthy tissues.Well-established cardiac risk factors such as obesity, smoking, hypertension and chronic periodontal disease all increase inflammation and CRP protein levels in the body.

As we’ve explained in past issues, adipose tissue functions as a virtual organ, spewing out hormones and compounds (including CRP) that raise disease risk, which is one reason why weight takes such a toll on the heart.But my cholesterol is fine? Nearly 27% of Americans are thought to have elevated (greater than 2.2 mg/L) levels of CRP, while nearly 7% may have levels higher than 10 mg/L.

What’s more, research indicates that up to 35 million Americans have a total cholesterol score within normal range but above-average levels of inflammation.What does elevated CRP mean? Normal CRP levels range from less than 1.0 mg up to 3.0 mg per liter of blood.According to the American Heart Association (AHA) and the Centers for Disease Control and Prevention (CDC), those with CRP levels greater than 3.0 mg/L have two times the relative risk for cardiovascular diseases.

The Women’s Health Study, which involved 39,876 healthy, post-menopausal women, found that those with the highest levels of CRP had five times the risk of developing cardiovascular disease and seven times the risk of having a heart attack compared with subjects with the lowest levels.This is key: CRP levels predicted risk even in women who appeared to have no other pertinent risk factors.

A Henry Ford Heart and Vascular Institute study published in the July 2003 issue of Circulation: Journal of the American Heart Association, analyzed data for the 5,417 men and women ages 65 or older who participated in the Cardiovascular Health Study and found that those subjects in the highest quartile of CRP levels were 60% more likely to have a stroke, compared to those with the lowest CRP levels.

Elevated CRP levels may even affect your eye health.

Harvard Medical School researchers found that C-reactive protein levels were significantly higher among people with advanced age-related macular degeneration (AMD) than those with no AMD.Whether or not the inflammation is a co-factor of AMD — or its result — needs to be further investigated.Lowering CRP levelsWhat to do if your CRP levels are high? The first place to turn may be the produce aisle of your local grocery store.A study published by St.Michael’s Hospital in Canada in the July 2003 issue of the Journal of the American Medical Association, found those who ate a diet high in vegetables, fruits, soy foods and nuts for one month lowered their CRP levels by an average of 28.2%.Which nutrients might be effective in keeping CRP in check? Initial evidence from USDA researchers at the Nutrition and Neurocognition Laboratory found an inverse relationship between blood levels of vitamin C and CRP.Researchers from the CDC replicated that result and found other nutrients which function like kryptonite to CRP, including alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein/zeaxanthin, lycopene and selenium.

But whoa — don’t go reaching for a remedy by raiding the supplement shelf.As we’ve reviewed before, antioxidant supplements will not reduce your risk of cardiovascular disease, while consumption of certain vitamin pills — A and E in particular — might raise your mortality risk.Here’s what to eat to get the anti-CRP antioxidants you need:
Vitamin C: red bell peppers, papaya, citrus, kiwis and broccoli.

Alpha carotene: carrots, butternut squash, pumpkin and persimmons.Beta carotene: butternut squash, cantaloupe, carrots and apricots.

Beta cryptoxanthin: butternut squash, pumpkin, red pepper and tangerines.

Lycopene: watermelon, tomatoes, pink grapefruit and pink-fleshed guava.

Selenium: brazil nuts, rye, salmon and brown rice.

What else can you do? Get active.Research presented at the 52nd annual meeting of the American College of Cardiology in 2003 found that people who exercised four or more times a week had CRP levels that were 34.6% lower than people who exercised less than once per week.Also, try chilling out.Duke University researchers found that people who are physically healthy but prone to anger, hostility and mild depression have levels of CRP as much as two or three times higher than their calmer counterparts.The study, published in the September 2004 Journal of Psychosomatic Medicine, observed that “fifty percent of all heart attacks occur among people without any traditional risk factors (obesity, smoking, diabetes, hypertension, high cholesterol and sedentary lifestyle), so it is critical to identify other factors” — like stress.To learn how listening can help lower stress, read on.


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