Inflammation May Be More Important Than Lipids in Atherosclerosis and Heart Disease
There is increasing evidence that inflammation is more likely to cause atherosclerotic heart disease than cholesterol.
As a young doctor many years ago, I was taught that the blood lipids (fats) caused atherosclerosis (hardening of the arteries). Decades later, we now know that this was an oversimplification, albeit partially true.
There is mounting evidence that blood fats, such as cholesterol and triglycerides, accumulate in injured blood vessels, but they are less likely to cause the initial damage. This is also known as “ passive cholesterol accumulation.”
A recent review sheds light on this important subject. However, before we delve deeper, it is essential to understand that there are two types of inflammation: beneficial and detrimental.
If you cut your skin, the area will become hot, red, swollen, and hard. This is the result of healing blood cells and the chemicals they release, which rush to the area of injury to repair the wound. This type of inflammation is beneficial and plays a key role in host defense and survival. This is good inflammation.
However, inflammation may occur in the absence of an obvious injury. When this happens, the lining of the blood vessels is inappropriately attacked by the same molecules and blood cells that repair a cut in the skin. This is bad inflammation.
Research has now shown that the latter type of inflammation may be one of the causes of the original damage to the lining of blood vessels, which in turn sets up more damage, which attracts blood fat deposits. In other words, blood fats are the result of the damage and not the cause.
It is also well known that certain blood tests, or biomarkers, help identify which people are at risk of this inappropriate inflammation. The most common one is “high sensitivity C-reactive protein” or hs-CRP. Many studies have shown that high hs-CRP levels correlate with heart disease.
Moreover, new imaging tests can now identify blood vessel inflammation at its earliest stages. In addition to blood tests, these tests help to identify patients at risk for future heart disease, such as heart attacks, strokes, and sudden death.
Unsurprisingly, the treatment for early inappropriate inflammation is the same as the standard lifestyle changes for known or clinical heart disease: quit smoking, follow a mostly plant-based diet, exercise, and control/treat diabetes, high blood pressure, and high lipid levels.
Finally, statin drugs, which improve lipid profiles, are anti-inflammatory and may be useful as well. Their anti-inflammatory properties may help to explain how these drugs aid in preventing heart disease as much or more than their lipid-lowering properties.
It has taken decades for all of this to be revealed. However, we are now more certain that control of sub-clinical, or inappropriate, inflammation may be as, if not more important, in the prevention and treatment of atherosclerotic heart disease.
I am a retired MD passionate about health, medicine, gardening, culture, and food.
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