A few years ago, we created an informative a white paper “Understanding Your Risks of Heart Disease. While the information is still very valid and important to know and understand, it was also time for an update. There is a lot of new information that has come to light in the last few years in regards to cardiovascular disease (CVD) we want to share with you.
In our first white paper on heart disease risks, we introduced you to a study called JUPITER (Justification for the Use of statins in Primary prevention: an Intervention Trial Evaluating Rosuvastatin). This study turned focus to a marker of cardiovascular inflammation called hsCRP (high sensitivity C-Reactive Protein). This study was of particular importance because it identified a new population of individuals at risk for heart disease. This study looked to examine why patients who had normal levels of cholesterol still ended up with CVD.
While this study was aimed at justifying the use of preventative treatment (statins therapy) with the subjects, Southwest Integrative Medicine took it as key data in determining where to look to understand risks for heart disease more broadly.
JUPITER Addresses Additional Risks for Heart Disease
For starters, JUPITER determined that there was more to CVD than high cholesterol and blood pressure, which is traditionally what physicians look at to determine your level of risk for heart disease. The fact that hsCRP levels alone predicted an increased risk for heart attacks and strokes is important for several reasons. For one it tells us that damage to the artery wall may be the real problem with cardiovascular health more so than cholesterol floating around and clogging things up. Possibly even more important is that it alerts us that hsCRP levels needs to be put in the list of items to check to stratify your risk of cardiovascular event.
Yet many people don’t have this marker checked and this study is now several years old. Rather than checking what the hsCRP level is and trying to find out why it is there, most doctors just prescribe lipitor or some other statin medication. This may work fine in the short term to lower hsCRP (for those that can take statin medication without side effects). However, what about those that can not take them or don’t want to? Additionally hsCRP is part of an alert system that tells us inflammation is present. The marker is not the inflammation itself. Reducing the hsCRP with a statin is the equivalent of shutting off a fire alarm when there is a fire and thinking there is not a problem. A more appropriate reaction is to find out why the hsCRP is high to start with.
More Recent Studies on CVD Risk
More recently, researchers have been looking at other markers that could be indicative of CVD and how it is related to inflammation and hsCRP. While inflammatory markers can be caused by several factors, this study looks at inflammation as it relates to something called Endothelial Dysfunction.
What is Endothelial Dysfunction?
Endothelial Dysfunction is a dysfunctional state of the inner lining of your blood vessels, or your endothelium. More specifically, this dysfunction is a shift in the balance between vasodilating (opening capacity) and vasoconstricting (closing capacity) substances produced by (or acting on) your endothelium (inside of your artery). This activity is governed by several substance that come from the endothelium. One of the main characterizations of this condition is reduced Nitric oxide production. When the artery wall encounters nitric oxide it causes the wall to relax and open. This is associated with more blood flow through the artery. With endothelial dysfunction there is decreased nitric oxide and therefore decreased blood flow (think high blood pressure and hardening of the arteries).
Endothelial dysfunction is an important aspect of both the early and late stages of atherosclerosis (artery blockage). For instance it plays a crucial role in the pathogenesis of cardiovascular issues including: acute coronary syndrome, hypertension, Peripheral Arterial Disease, Erectile Dysfunction, stroke, etc. Additionally, once the arteries are blocked this ability of the artery to expand and increase blood flow become even more important.
Most research seems to support the fact that endothelial dysfunction perpetuates cardiovascular disease. Therefor if we can detect and treat it early, we may be able to reverse or prevent cardiovascular disease. Additionally looking at the connection between inflammation (hsCRP) and endothelial dysfunction may point us to a true cause.
Endothelial Dysfunction and Inflammation
As noted above decreased nitric oxide production is one of the hallmarks of endothelial dysfunction. By making use of the amino acid arginine, nitric oxide is produced by an enzyme called nitric oxide synthase. This works perfectly fine when there is enough biopterin around to support nitric oxide synthase. This enzyme needs biopterin as a cofactor to do this work. However inflammation in the body impairs biopterin production and use which leads to reduces nitric oxide production. While that is pretty convincing, there is other evidence that inflammation creates and perpetuates endothelial dysfunction.
Homocysteine is a molecule that is also associated with cardiovascular disease. As it turns out homocysteine accumulation also reduces nitric oxide production. However, this could be the impact of inflammation on enzymes involved in reducing homocysteine. We know inflammation does lead to high homocysteine. We also know that several other things could cause high homocysteine so it is important to not draw do many conclusions on what is causing what. However, since high homocysteine alone is linked with impaired nitric oxide this should be kept imbalance as much as hsCRP.
What You Need to Know About Inflammatory Markers
There are many ways to lower the levels of inflammation and homocysteine. One study looked at the role of different pharmacological and nonpharmacological agents to restore endothelial dysfunction. Before looking at ways to lower it, the first step is to test your levels so you know what the baseline is and if treatment is even needed. If you know there is a problem here, the next step is to find and treat the cause, instead of just the number. Factors like infection, autoimmune disease flare-ups, elevated blood sugar, toxin exposure (heavy metals and other toxin exposure) are just a few common causes of inflammation. Homocysteine elevation is typically caused by too little consumption or absorption of vitamin b12, and folate. Some people also have a genetic factors that influence these.
What is important to remember is that Endothelial Dysfunction is relatively reversible when it is treated properly. When you look at the risks for cardiovascular health from a broader perspective, it translates into an improvement in endothelial health and heart health.
Lets not forget the impact of a general unhealthy lifestyle heart disease risks. Here are some of the most common unhealthy lifestyle choices that increase your risks for one reason or another:
- Excessive alcohol consumption
- Lack of exercise
- High saturated fat diet
- Not enough water intake
- High sugary foods and poor blood sugar control
When trying to determine your overall risk for heart disease and a cardiovascular event, look beyond blood pressure and cholesterol. There are several more advanced tests available that look at the things mentioned in this article, Lp(a), LDL particle size and more. If you want to reduce your risk, make sure you are getting a thorough evaluation from your doctor.
For more information on heart disease risk and integrative treatments for heart disease, click below or give us a call 480.451.5407.