Inflammation: the new paradigm for heart disease

Conducted in over 40 countries, the study tested whether decreasing inflammation would reduce risk of cardiovascular-related death in patients with a heart attack history.

Over 10,000 men and women participated in the study, the mean patient age being 61. Every participant had elevated CRP, an inflammatory marker determined by a blood test.

The Cantos study found that Canakinumab - an anti-inflammatory medication currently approved only for use in the US and Europe for certain rare inflammatory disorders - was more effective than a placebo for preventing future cardiovascular events, including cardiovascular death from a heart attack or stroke.

“This really proved the inflammation hypothesis,” Sydney Cardiologist Associate Professor Edward Barin said. “For the first time researchers did something [to address] inflammation directly and [in turn] reduced heart disease.” The effect was unrelated to changes in serum cholesterol levels. 

“This treatment concept [is currently] just based on one trial, but the data linking heart disease risk to inflammation has been there for some time,” he said. Barin referred to a number of statin trials including the Jupiter, Prove-it, and Reversal trials, which linked reduced risk of cardiovascular events to reduced levels of the inflammatory marker CRP.

“We are beginning to think of heart disease as being an inflamed condition. But inflammation is not as novel an idea as it would seem. Type 2 diabetes for example is a classic inflamed condition. If you measure inflammatory parameters, you pick up a lot of clues that the body is inflamed,” he said. Forty per cent of Cantos study participants had diabetes.

“Inflammatory autoimmune diseases like rheumatoid arthritis and psoriasis also increase the risk of cardiovascular disease, that’s now well recognised.”

Inflammation can be the result of unnecessary oxidation in the body, Barin said. “Inflammation damages the endothelium (cells lining the interior surface of blood vessels and lymphatic vessels), which can result in particular damage by cells such as oxidised macrophages,” white blood cells that form part of the immune system. “All this misbehaviour can be detected and measured in the blood,” he said.

“The final result of inflammation is that it activates the immune response inappropriately, and the body becomes ill and difficult to repair. So [it might be that] the inflammation cascade that causes disease is an out-of-control mechanism.”

“People who have a lot of body fat have been shown to have a lot of raised inflammatory markers, but inflammation is not [only due to] weight,” Barin said.

“Diet is more than just reducing cholesterol and calories. This hasn’t been proven yet, a host of nutritional studies suggest that we need to start thinking about implementing Mediterranean-style anti-inflammatory diets.”

A diet high in meat, alcohol and sugar, and omega-6 rich seed-based diets will promote inflammation, whereas a diet rich in fresh plant-based produce and marine omega-3s can have the opposite effect, Barin said.

“Poor sleep hygiene is linked with increased inflammation markers, so is mental stress,” he said.

“Talk to your doctor about inflammation because it can be a strong pointer to heart disease and stroke. Treating it has now been proven beneficial and we should direct effort to reducing inflammation in a more holistic way.”