C-Reactive Protein Test Measures Vulnerable Blood

January 6, 2004
NYTimes.com>PERSONAL HEALTH

Hunt for Heart Disease Tracks a New Suspect
By JANE E. BRODY

Little by little, research has helped Americans chip away at what was once a runaway epidemic of premature heart disease, which claimed the lives of far too many people, especially men, in their 40's and 50's.

We learned through extensive and costly long-term studies that cigarette smoking, elevated serum cholesterol levels, uncontrolled high blood pressure and diabetes placed people at greatly increased risk of heart disease and sudden cardiac death.

We also learned that people could control these major risk factors and reduce their chances of developing heart disease or dying from it if they quit smoking, changed their diets and, when necessary, took drugs to lower cholesterol, blood pressure or blood sugar. As a result, the number of Americans living beyond age 65 has more than doubled since 1960 even though the population has increased just 50 percent. But the battle is far from over. Cardiovascular disease is still the major killer of middle-aged men and by far the leading cause of death for Americans over all. For about half of those who die from heart disease, the very first symptom is sudden death. About 250,000 sudden cardiac deaths occur each year in the United States.

For many who die this way, high cholesterol, now the main focus of prevention efforts, is not a factor.

Cholesterol screening fails to identify 50 percent of the people who have heart attacks in the United States each year, because their total cholesterol is either normal or only moderately elevated, noted Dr. Eric S. Rawson of the University of Massachusetts Medical School and colleagues in the journal Medicine & Science in Sports & Exercise in July.

A New Risk Factor"
"It is apparent that a substantial proportion of cardiovascular events occurs in individuals without established risk factors," Dr. Daniel G. Hackam and Dr. Sonia S. Anand of McMaster University in Ontario, Canada, wrote in August in The Journal of the American Medical Association. And so researchers are still looking for new factors that seem to increase the risk of developing heart disease or dying from it.

One emerging factor is a substance called C-reactive protein, or CRP. It is a natural chemical produced in the liver and released into the bloodstream in the presence of acute or chronic inflammation. High levels of the chemical may explain why some people with low cholesterol develop heart disease or why rigid adherence to a cholesterol-lowering diet sometimes fails to prevent serious heart problems.

In a study by researchers at Johns Hopkins, published in July in Circulation, healthy middle-aged people with high levels of C-reactive protein experienced less reduction in serum cholesterol and a greater rise in triglycerides when they followed a cholesterol-lowering diet than did a comparable group with low levels of CRP.In the continuing Physicians' Health Study of 22,000 men, 97 apparently healthy participants suffered sudden cardiac deaths. The only factors predictive of their fates over 17 years of study were elevated C-reactive protein levels, Dr. Christine M. Albert of Brigham and Women's Hospital and her Boston colleagues reported in May 2002 in the journal Circulation.

In women, too, the C-reactive protein appears to be a better predictor of heart attack, stroke and other signs of cardiovascular disease than the so-called bad cholesterol, low density lipoprotein, or L.D.L. In a study of 28,000 apparently healthy American women followed for an average of eight years, levels of C-reactive protein were directly related to the development of cardiovascular events like heart attacks and strokes and more strongly predicted such problems than levels of L.D.L. cholesterol, Dr. Paul M. Ridker and colleagues at Brigham and Women's Hospital reported in November 2002 in The New England Journal of Medicine.

Normally, there is no C-reactive protein in blood, but various tissue injuries, infections and diseases are associated with its appearance, among them rheumatoid arthritis, cancer, pneumococcal pneumonia and heart attacks. It may also be present late in pregnancy and in women taking oral contraceptives.

The role of C-reactive protein as a contributor to cardiovascular disease fits nicely into the understanding that inflammation is central to every stage of atherosclerotic disease, from the start of plaque formation in arteries to the rupture of those plaques, which can precipitate a heart attack or stroke.Basic research has shown, for example, that CRP can enhance destruction of arterial lining cells, activate adhesion molecules and blood clotting factors and interfere with substances that increase circulation to the heart.

Furthermore, a new study by heart and kidney specialists in South Korea suggests that C-reactive protein is "an independent risk factor for the development of hypertension," which in turn increases the chances of suffering a heart attack or stroke.

In a study in Munich, cardiac patients treated with arterial stents to improve coronary blood flow were more likely to suffer heart attacks or die within 30 days of their insertion if they had high levels of CRP.

According to Dr. Hackam and Dr. Anand's review of the literature, chronic low-grade inflammation appears to underlie many, if not most, cases of cardiovascular disease, and, they concluded, even small increases in CRP can predict "future vascular events in apparently healthy, asymptomatic individuals.

"An analysis of 14 long-term studies indicated that compared with people with the lowest levels of C-reactive protein, those with the highest had twice the risk of heart attacks.

Among patients known to have atherosclerotic heart disease, those with the highest levels of CRP were about four times more likely to experience symptoms of impaired blood flow to the heart during a treadmill test, indicating a direct relationship between inflammation and a heart attack, researchers at the University of California at San Francisco reported in Circulation last January.

"Our study supports the idea that heart disease is more of a systemic disease rather than just a plumbing problem," said Dr. Mary S. Beattie, the study's lead author. Based on such findings, some experts believe that levels of C-reactive protein are better than cholesterol levels at predicting future cardiac events. Patients can lower their CRP levels if they lose weight, quit smoking, change their diets and exercise more. Many drugs may also help, especially the cholesterol-lowering statins and the antidiabetic thiazolidinediones.

Should CRP Be Measured?
C-reactive protein can be measured by a simple, inexpensive blood test. The best results are obtained through two tests that are done at least two weeks apart with their results averaged.

In March 2002, experts from the Centers for Disease Control and Prevention and the American Heart Association concluded that patients deemed to be at "intermediate risk" of a heart attack, stroke or other cardiovascular event should be tested for C-reactive protein.

Intermediate risk is defined as those with a 10 percent to 20 percent chance of developing coronary heart disease within 10 years, based on age, total cholesterol level, smoking status, systolic blood pressure (the upper number) and blood level of protective H.D.L. cholesterol.

The experts recommended that those with C-reactive protein levels of 1 milligram per liter or more take aggressive action to reduce the level. The experts, however, do not recommend CRP testing either for those at otherwise low risk of heart disease or for those known to be at high risk - those who already have signs of trouble, since they should already be getting aggressive treatment.

Comment:
Basic research has shown, for example, that CRP can enhance destruction of arterial lining cells, activate adhesion molecules and blood clotting factors and interfere with substances that increase circulation to the heart. It may help YOU to save YOUR patients lives by getting them to understand the need for LONG TERM anti-inflammatory and anti-clotting THERAPY. Starting with OMEGA-3 oils and going from that into the other ingredients in BEYOND CHELATION IMPROVED, you might get many more patients to see the wisdom in treating the blood stream and NOT operating on the arteries!

In fact, Dr. Valentin Fuster MD, PHD at MT Sinai, Chief of Cardiology and Past President of the American Heart Association and Editor of their book called Vulnerable Plaque, has now CHANGED the terminology. It is NO LONGER just called VULNERABLE PLAQUE, he NOW has called it VULNERABLE BLOOD and WE have the answer!

This article, I believe properly UNDERLINED to HIGHLIGHT some of the key words like adhesion and blood clotting, will empower your patients to CHOOSE your program over any other out there to avoid THEIR heart attacks and strokes. Please learn NOW that a normal C-reactive can change virtually OVERNIGHT when ANY infection/inflammation activates.

So do not treat only the abnormally elevated C-reactive protein levels, as low dose prophylactic therapy with Beyond Chelation Improved taken AM and PM provides significant protection for everyone. While those with abnormal readings, or serious symptoms, or family history, or other abnormal findings will probably warrant even MORE protection, which is where Endozym (when you need BOTH anti-inflammatory and anti-clotting effects) and Endokinase can be added.

Sincerely,
Garry F. Gordon, MD,DO,MD(H)

For complex medical questions, we advise that you make an appointment for a personal, recorded, telephonic consultation with me. Each consultation is recorded and provided to you on audio CD. To schedule an appointment, call (928) 472-4263, Monday through Friday, during standard business hours.