WEDNESDAY, Nov. 13, 2002 (HealthDayNews) -- A molecule called C-reactive protein may be a better indicator of future heart trouble than cholesterol, and now cardiologists are wondering what to do about it.
Women with high blood levels of C-reactive protein were more likely to have a "cardiovascular event" -- such as a heart attack or comparable problem -- than those with high levels of LDL cholesterol, the "bad" kind that clogs arteries, a new study says.
Three-quarters of the cardiovascular events recorded in the Women's Health Study occurred in those whose LDL cholesterol readings were below the level regarded as dangerous. However, they had elevated levels of C-reactive protein, according to the study researchers at Brigham and Women's Hospital in Boston.
The study, which followed nearly 28,000 women for an average of eight years, appears in tomorrow's issue of The New England Journal of Medicine.
So should the same kind of blood-test screening now done to detect high cholesterol levels be done for C-reactive protein?
Not just yet, says Dr. Lori Mosca, director of preventive cardiology at New York Presbyterian Hospital, who wrote an accompanying editorial in the journal.
"We do have definitive evidence that lowering LDL cholesterol levels reduces the risk of heart disease," she says. "We don't have the same degree of evidence about C-reactive protein. We need to have studies showing that lowering levels of C-reactive protein lowers the risk of heart disease."
C-reactive protein is a protein whose level increases when there's inflammation of blood vessels, according to the American Heart Association.
The new study adds to the evidence that inflammation is somehow involved in heart disease, Mosca says, so the prudent thing to do is to make lifestyle changes that reduce the occurrence of inflammation. And those changes are the sorts of things now recommended for healthier hearts -- such as low-fat diets and more exercise, she says.
"The bottom line is that individuals at high risk of heart disease should take advantage of all existing therapies," Mosca says. "People at low risk should use lifestyle management."
The Women's Health Study findings fit in with what is missing about our knowledge of heart disease risk, says Dr. Nieca Goldberg, chief of the women's heart program at Lenox Hill Hospital in New York City. In general, elevated LDL cholesterol levels explain only half of heart disease risk, she says, "so we need to look for newer risk factors."
If C-reactive protein does prove to be such a risk factor, steps to manage it are available, Goldberg says. A blood test for C-reactive protein is easily done. And the statins prescribed for high cholesterol also reduce C-reactive protein levels. Aspirin, widely used as a heart disease preventive because it prevents blot clots, also has anti-inflammatory properties, she notes.
For now, Goldberg recommends C-reactive protein screening only for people at very high risk of heart disease, such as those with a strong family history or those who already have suffered a heart attack.
Mosca believes that widespread use of drug therapy to lower C-reactive protein levels should begin only after carefully controlled studies show that doing so reduces the incidence of heart disease. Such studies, in which some people get protein-lowering treatment and others do not, are just beginning, she says.
What To Do
Information about C-reactive protein is offered by the American Heart Association. To learn more about heart disease, visit the U.S. National Library of Medicine.
