Inflammation Playing a Much Bigger Role in Heart Disease Evaluations
Inflammation Playing a Much Bigger Role in Heart Disease Evaluations
Highlighted in June 2025, from a Medscape article originally published in May 2025.
Key Points:
1. Inflammation Takes Center Stage:
• Inflammation is emerging as a central factor in cardiovascular risk, alongside or even above cholesterol.
• Dr. Paul Ridker of Harvard emphasizes that high-sensitivity C-reactive protein (hs-CRP) is a key biomarker that can guide both prediction and treatment of heart disease.
2. CRP Outperforms Traditional Risk Markers:
• Long-term data from the Women’s Health Study (30,000 women over 30 years) show that hs-CRP is a stronger predictor of cardiovascular events than LDL or Lipoprotein(a).
• Ignoring inflammation in risk assessment may result in missed opportunities for early prevention.
3. Screen What You Want to Treat:
• Ridker calls for routine testing of hs-CRP, LDL, and Lp(a) in both primary and secondary prevention.
• “Doctors don’t treat what they don’t measure”—inflammation should be screened and addressed like blood pressure or cholesterol.
4. Pharmaceutical Innovation:
• In 2023, colchicine became the first FDA-approved drug specifically targeting coronary inflammation.
• Other drugs, including GLP-1 receptor agonists and SGLT2 inhibitors, also show CRP-lowering effects.
• Ongoing research is exploring targeted therapies along the IL-1 → IL-6 → NLRP3 pathway, relevant to atherosclerosis, HFpEF, and more.
5. Direct Imaging of Inflammation:
• New techniques like fat attenuation index (FAI) using cardiac CT allow direct visualization of perivascular inflammation.
• These tools complement blood biomarkers like CRP, which reflect systemic rather than localized inflammation.
6. A Simpler, Smarter Approach to Prevention:
• Ridker warns against over-reliance on costly imaging.
• He advocates for a simple, cost-effective model using history, physical exam, and three blood tests: LDL, CRP, Lp(a).
• These tests can guide family screening and catch silent risk early in both prevention settings.
