U.S. studies point to protein role in heart attacks

It's not enough to reduce "bad" cholesterol to prevent heart attacks because a substance called CRP also must be kept low, doctors said on Wednesday in a finding that could save tens of thousands of lives.

Fortunately, it appears that statins - the same types of drugs that have been shown to reduce low-density lipoprotein or "bad" cholesterol - also bring down CRP, or C-reactive protein.

Evidence has been growing that a special type of inflammation, different from the form treated with aspirin and other related drugs, contributes to heart disease. CRP measures that inflammation.

A study led by Paul Ridker of Brigham and Women's Hospital in Boston showed that the people with the lowest risk of suffering a second heart attack also had the lowest levels of CRP.

A second study, led by Steven Nissen of the Cleveland Clinic, found that among 502 patients who lowered their CRP levels the most, there was ultrasound evidence that their clogged arteries had opened up a bit.

Both studies appeared in this week's issue of The New England Journal of Medicine.

Ridker said the findings have "the potential to save thousands of lives" and should radically change the way the public thinks about heart disease prevention.

"It's no longer enough to monitor cholesterol levels if we want to do enough for our patients," Ridker told AMN Health.

The Ridker group discovered that among 3,745 heart attack victims treated with statins, the risk of having a second heart attack after 2-1/2 years was nearly 10 percent among those with high levels of CRP and LDL cholesterol. Bringing down either the CRP or the LDL cholesterol shaved that risk to about 7 percent.

But when both levels were cut, the risk dropped to 4.9 percent.

CRP levels of less than 1 milligram per liter of blood brought the risk down to 4 percent.

One blood test isn't enough, the researchers found, because cholesterol and CRP levels are independent of each other.

SOURCE: New England Journal of Medicine, January 5, 2005.