Statins - a double dose of heart protection

Nearly every day is bringing new evidence that if you want to protect your heart, you may have to pay a lot more attention to your teeth, your stomach, and lots of other areas that on first thought you wouldn't have associated with damage to your heart.

Why? Because "inflammation" is fast joining high cholesterol levels as a major threat to your cardiovascular system. You see, it's long been known that half of all heart attacks occur in people with seemingly normal cholesterol levels. That means either that so-called "normal" cholesterol levels may actually be too high (and there is evidence that some people - those with extra cardiac risk factors - really should aim for the lowest possible cholesterol levels, not just those that are at the higher range of "normal"), or that there is more to the why your blood vessels plug up than simply the fat content of your blood stream. That "something" is probably inflammation.

Most experts now accept that a major cause of why your heart gets damaged is through inflammation of the endothelium, the lining of the arterial wall, and when those endothelial cells become damaged, they are more prone to developing those fatty plaques that are the cornerstone by which we diagnose atherosclerostic damage to vessel walls. There's also this: inflammation of the endothelial cells probably has its source in other locations in the body: gum disease, for example, or the stomach bugs that cause ulcers but which many people carry "silently".

So what is the evidence for this theory, you wonder. As a start, several studies have shown that people with higher levels of a chemical called c-reactive protein (CRP) in their blood have higher risks of heart disease and stroke, and the higher the CRP levels, the worse that risk. CRP is a marker for inflammation.

In another recent study, a researcher took a group of people who had suffered heart attacks and randomly assigned some to get antibiotics, and some to get placebo. At the end of a year, the group on antibiotics had fewer second heart attacks and fewer episodes of chest pain requiring urgent intervention. Antibiotics, of course, counteract infection, which is a type of inflammation (more on this below).

There's more evidence from a practical perspective. It is now thought that part of the reason that that group of drugs known as statins (Lipitor, Zocor, Pravachol, etc.) are so effective at lowering the rate of heart attack is not just because they lower cholesterol levels (which they do), but also because they exert an anti-inflammatory effect as well (they lower levels of CRP). So when you take a statin, you are getting a double dose of heart protection.

So now for the good news (sort of): you can lower your risks of heart attack by lowering your levels of CRP, that is, by lessening the inflammation in your body, but it's the same-old, same-old, I'm afraid (I did say "sort of good news"). CRP levels have been shown to go down with weight loss (in the overweight) and exercise. Inflammation also goes down, of course, with the regular use of ASA, although ASA is a powerful drug with several potential side effects, particularly on bleeding tendencies, so discuss it with your doctor first before starting on ASA for this reason.

And as previously stated, of course, statin drugs have also been shown to lower CRP levels.

But what about antibiotics? Why doesn't everyone just take a week's worth of antibiotics once a year to protect their heart? First, because we still have no idea why antibiotics might work for this problem (in the study I noted earlier in which antibiotics did work, even the researcher who headed the investigation says he doesn't know why that happened) and second, because, the potential side effects of such an approach - especially the potential for bacterial resistance to those drugs - is far too great.

The tried and true advice to lose weight, eat right etc, still holds as true as ever. However, keeping an eye on the latest research in this area may well help you treat yourself and design your preventative measure more effectively.

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