Heart disease is one of the most common causes of death
Sebastian Kaulitzki/Science Photo Library/Getty Images
Doctors are in the midst of a major rethink about what causes heart attacks and strokes, one of the most common causes of death worldwide.
For decades, much of the focus has been on cholesterol.Statins, used to lower cholesterol, are the most commonly prescribed drugs for preventing cardiovascular disease in the UK. But a growing number of researchers say this overlooks another important factor. It is inflammation associated with the background activity of the immune system.
A study this week found that among people taking statins to lower cholesterol, inflammation was a bigger risk factor for heart attack and stroke than whether cholesterol levels were still high. If we don’t start, it’s clear we can’t beat this disease,” says Paul Lidker of Brigham and Women’s Hospital in Boston, who worked on the study. “It’s no longer a hypothesis. It’s a proven fact.”
The idea of targeting cholesterol to treat cardiovascular disease is largely the result of a large study that found that higher levels of “bad cholesterol” correlated with higher rates of heart attacks.
Another clue was that cholesterol is one of the main components of fatty plaques that form on the walls of arteries and restrict blood flow to major organs. It occurs because plaque ruptures and can block small blood vessels downstream.
Once this was understood, cholesterol-lowering statins became one of the most common drugs in use.More than 200 million people worldwide take statins. This is because they are believed to have survived or are at risk of developing a heart attack or stroke. Many large trials have found statins to be highly effective in reducing heart attacks, reinforcing the cholesterol theory of heart disease.
So where does inflammation come from? The revised idea is that these plaques are not simply inert blockages, but are kept alive by the activity of immune cells. into the bloodstream. And recent evidence suggests that statins may act by reducing inflammation and lowering cholesterol.
Despite increasing evidence of the importance of inflammation, it has yet to become a new way to prevent or treat cardiovascular disease. But that may be changing.
In the new study, Lidker’s team analyzed figures from three large trials, each testing a different treatment aimed at reducing heart attacks and strokes in people taking statins.
The results of these treatments are not relevant here. At the beginning of the trial, the participants’ blood was subjected to a battery of tests, including cholesterol and a compound called her C-reactive protein (CRP), which is a hallmark of inflammation.
All three trials found that high CRP was associated with more deaths from cardiovascular disease than high cholesterol. People in the participant’s quarter with the highest CRP had a 268% higher risk than the quarter with the lowest.In contrast, high cholesterol only increased the risk by 27%.
Knowing that inflammation is part of the disease process is of little use unless you can do something about it. Tested.
One of the most promising is a plant-based compound called colchicine, which is already used to reduce inflammation in gout sufferers. His two recent randomized trials also show that colchicine reduces stroke and heart attacks by about 30%, similar to statins.
Colchicine is not approved for the prevention of cardiovascular disease outside of Canada, but was considered an option in the European Society of Cardiology guidelines in 2021. Physicians can prescribe it “off-label” if recommended by a similar body in the UK, says Nilesh Samani of the University of Leicester, UK, who was not involved in the latest study.
A word of caution, people who have had a heart attack or stroke may already be taking many pills, and the more pills they take, the more likely they are to interact and cause unwanted effects. is higher. Not to mention the inconvenience of multiple drugs.
Nevertheless, there is growing evidence that physicians need to place as much importance on tackling inflammation as they do on cholesterol to prevent heart disease and stroke. “It’s neither, it’s both,” says Jean-Claude Tardif of the Institute.
“Often in science, it’s a series of incremental steps that ultimately lead to big changes. This paper brings this to the fore.”
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