"Is a Heart Attack or Stroke in Your Future?” Part 1

By Dr. Greg Fors, DC / Board-certified Neurologist

Heart disease is the leading cause of death in the United States and a major cause of disability. Every 25 seconds, an American will have a heart attack, and every minute someone dies from it (Circulation 2011; 123). Heart disease is the leading cause of death in men and the first symptom of any heart disease in over half of these men is death itself. Over ¾ of a million Americans will suffer a stroke this year. Most of these strokes could be prevented through proper risk factor identification and management.

Most Americans believe that heart disease is caused by high cholesterol or the bad cholesterol LDL and if they take a cholesterol lowering drug you can prevent a future heart attack. If you are one of those individuals you may be surprised to hear about a recent study from the prestigious UCLA School of Medicine. They found that 75% of patients hospitalized for a heart attack had low levels of the “bad” cholesterol LDL below 130 mg/dl, easily within the safe range. Also 21% were taking a statin cholesterol-lowering drug. Even more shocking was that 50% of those suffering a heart attack had optimally low levels of LDL, less than 100 mg/dL!  

Most scientists now agree that heart disease and heart attacks are not caused by cholesterol but brought on by chronic inflammation and oxidative stress. These two factors almost always appear together in the body and must be defended against. Cholesterol is one of the most important nutrients in the body; we make hormones from it and repair ourselves with it. Cholesterol also acts as a primary antioxidant just like vitamin C and as an anti-inflammatory. Therefore cholesterol levels rise in response to inflammation and oxidative stress in the body's attempt to put out the fire and repair the damage. When because of dietary and lifestyle factors arterial inflammation persists and cholesterol loses the battle, the oxidized LDL cholesterol gets the blame. It's a bit like blaming the firemen's water for an uncontrolled fire!

So if chronic inflammation is the source of the problem how can you tell if it's a problem for you? One of the best biomarkers for this process is an inexpensive blood test called “high-sensitivity” CRP. More than a dozen major studies demonstrate that hsCRP levels are highly predictive of future risk of heart attack, stroke, sudden cardiac death, and the development of peripheral arterial disease. Individuals with elevated levels of hsCRP are 3 times more likely to develop heart disease and elevated hsCRP also predicts the risk of developing type II diabetes.

Another important inexpensive biomarker to have measured to predict problems with chronic inflammation is a protein synthesized in the liver called Fibrinogen. It circulates in the blood and plays a vital role in blood clotting. Therefore elevated levels do play a role in the risk for blood clots in heart attacks and strokes. Levels of fibrinogen increase with tissue inflammation or tissue destruction. A large-scale 2002 European study showed that "fibrinogen is a powerful predictor of stroke" - including fatal and nonfatal strokes, first time strokes, and hemorrhagic and ischemic strokes.