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Inflammation: A Hot Topic for the Heart

This Slow "Burn" Can Fire Up Health Hazards

Anyone who has ever skinned a knee knows about inflammation. Those familiar symptoms of heat, redness, swelling and pain are all part of the body's healthy immune response to injury or infection. Without this kind of inflammation - the "acute" kind - our wounds and infections would never heal.

But inflammation isn't always a good thing. In chronic inflammation, the body's immune defense goes haywire and destroys cells instead of healing them. Scientists think this hidden process may be at the root of heart disease, stroke, certain cancers, allergies, arthritis, Alzheimer's disease, Parkinson's disease and many other serious conditions.

Mysterious though chronic inflammation may be, there are tests to measure its impact of on your heart and things you can do to keep it on the back burner. We asked Dr. Peter Oettgen, Director of Preventive Cardiology and the Cardiovascular Health and Lipid Clinic at BIDMC, to help us understand this silent scourge.

HeartMail: What is acute or "good" inflammation?

Dr. Oettgen: The body's white blood cells rush to our defense in an attempt to rid the body of foreign matter. This increases the blood flow to the area, causing warmth and redness. Chemicals emitted by the white blood cells can cause fluid to leak into tissues, which results in swelling. If nerves in the area are affected, pain can occur. This is short-term inflammation, which subsides as healing begins.

HeartMail: So far so good. What happens when inflammation goes bad?

Dr. Oettgen: Sometimes the body turns on the heat of inflammation and keeps the fires burning steadily instead of easing back. The causes can be numerous - smoking, a poor diet, diabetes, or high blood pressure can all keep the process going. So, inflammation makes itself at home in the body, like an unwanted guest. When inflammation persists, a multitude of health issues can occur, depending upon the part of the body where it settles.

HeartMail: How does this affect the heart and cardiovascular system?

Dr. Oettgen: Chronic inflammation can build in the cardiovascular system when cholesterol and fat deposits accumulate within the walls of arteries. The fatty lining in arteries can cause plaque to form within the vessels, reducing the flow of blood. This process can lead to hardening of the arteries - atherosclerosis - which can result in coronary heart disease. Atherosclerosis is the leading cause of death in America.

When the lining of arteries is damaged by high cholesterol, smoking or high blood pressure, atherosclerosis and the formation of plaque in vessel walls begins. Unfortunately, atherosclerosis often has no symptoms until middle age or later.

Blood vessels can become filled up with so much plaque that blood flow is severely limited, causing pain or angina as a symptom. The real danger occurs when the plaque lining ruptures or forms a blood clot resulting in the total blockage or occlusion of the blood vessel. This leads to a heart attack.

HeartMail: Can inflammation cause any other kind of heart disease?

Dr. Oettgen: It has also been associated with congestive heart failure, valvular heart disease, peripheral artery disease and sudden cardiac death.

HeartMail: How can a person know whether he or she has atherosclerosis before it becomes symptomatic?

Dr. Oettgen: Blood tests are sometimes used to identify markers for inflammation, such as C-reactive protein (CRP), to determine whether patients have underlying inflammatory conditions. CRP is a molecule produced by the liver in response to certain inflammatory signals. Transient elevations of CRP are normal after an injury or infection. But CRP levels that are consistently elevated over time are a sign of systemic inflammation.

Testing CRP levels in the blood can be a way to assess cardiovascular disease and help predict the risk of heart attack or stroke and direct treatment and therapy. A CRP test is most effective for individuals who are in the intermediate risk category for developing cardiovascular disease.

HeartMail: Is there anything one can do to "turn down the heat" - to prevent inflammation-related disease?

Dr. Oettgen: Low-grade inflammation can be kept simmering by unhealthy lifestyle habits such as cigarette smoking, a high-fat diet, high salt intake, stress and lack of exercise.

You can "cool down" or calm inflammation through healthy living habits, including diet and exercise and, if needed, proper medication. An anti-inflammation diet is similar to the Mediterranean diet and emphasizes fresh fruits, vegetables, poultry, fish, whole grains and healthy fats such as extra virgin olive oil. Avoid sugar, salt, processed or fast foods and saturated or trans fats such those in red meat. Maintain a healthy weight, get plenty of sleep each night and exercise regularly. Quit smoking and only drink alcohol in moderation.

For those who can't regulate their cholesterol or high blood pressure through diet and lifestyle alone, a physician can prescribe medications that will slow or stop the progression of atherosclerosis, while reducing the risk of heart attacks and stroke.

HeartMail: Okay, we get the idea! We can all be "cool" and head off the heat of inflammation by getting up and out, eating well and scheduling regular visits to the doc. And we'll try not to skin a knee on the way!


Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted October 2010