A Better Way to Screen for Heart Disease?

Research suggests that using statins to lower CRP levels might save lives.

Video: The Dangers of Heart Disease
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One confounding factor in Jupiter, experts point out, is that the drug used to lower inflammation—rosuvastatin, manufactured by AstraZeneca (which funded the study)—also dramatically lowered levels of harmful LDL cholesterol. Siscovick says this leaves open the question of whether the benefits were largely due to the statin's cholesterol-lowering effects, even though participants' LDL levels weren't elevated. Schwartz concurs and wonders whether a drug that targets only inflammation, like aspirin, might have worked as well as a statin in people without obvious heart disease.

Still, given the edge that statins demonstrated over placebos, why not make CRP screening as routine as cholesterol and blood pressure checks? After all, Schwartz estimates that half of American adults would be flagged as having high levels, defined by the Jupiter study as more than 2 mg per liter of blood. Trouble is, she says, this could swell the ranks of people on statins by millions. The drugs are considered to be very safe, but they do have side effects, such as disabling muscle pain. In rare cases, they elevate liver enzymes and cause severe muscle deterioration and kidney malfunction. While the Jupiter trial didn't detect a significant increase in these problems, Ridker admits that the study size may not have been large enough to detect unusual complications. And for reasons that aren't clear, the people taking statins were slightly more likely to develop diabetes during the study than the placebo group.

As doctors and public-health experts tussle over whether to look for and treat inflammation more aggressively, ordinary folks can act now to make some inflammation-fighting lifestyle changes. The Jupiter participants, with a typical CRP level of 4 mg per liter, weren't exactly the picture of health: Most of them were overweight, and many had metabolic syndrome, a precursor of diabetes that is characterized by high blood-sugar levels, too much abdominal fat, and high blood pressure, for example. Some were smokers. If this sounds like you, you probably have increased inflammation, too. A growing body of evidence suggests approaches beyond statins also lower CRP levels:

Smoking cessation. Smoking is associated with higher levels of CRP and has been shown to harden arteries, aggravating the effects of inflammation. But the damage needn't be permanent: A 2007 study published in Hypertension revealed that within 10 years of quitting, former smokers' arteries look like those of people who've never smoked. On the other hand, middle-age smokers have about double the risk of dying from heart disease and strokes compared with nonsmokers.

Heart-healthy diet. Italian researchers have shown that CRP levels decreased by an average of 0.8 mg per liter over two years in obese premenopausal women who increased their activity and adopted a Mediterranean-style diet centered on fruits, vegetables, whole grains, nuts, and fish instead of red meat and processed foods. "An anti-inflammatory diet is about reducing saturated fat and trans fats and eating more foods rich in alpha-linolenic acid—like flax seed, walnuts, and canola oil—and omega-3 fats, which fight inflammation," says Evangeline Lausier, a staff physician at Duke Integrative Medicine. She frequently recommends this diet to patients reluctant to take statins. On the flip side, a study published last month in the journal Circulation found that the typical American fast-food diet increases heart attack risk by 30 percent.

Physical activity. While a single bout of strenuous exercise can temporarily increase inflammatory chemicals, your body reaps anti-inflammatory benefits from a regular fitness routine, says Stanley Hazen, head of preventive cardiology at the Cleveland Clinic. An ideal amount for a healthy individual is five days a week of steady exercise (brisk walking, swimming, biking) for 30 to 45 minutes, he says. Do, though, avoid the kind of workout that leaves you very sore; this causes a spike in inflammation as the body rushes to heal itself.