The evidence linking elevated cholesterol to heart-disease risk may be rock-solid, but there are still mysteries. One of the most perplexing is the fact that as many as one-third of heart attacks occur in people with perfectly normal cholesterol levels. And many people with high blood-cholesterol readings show no signs of clogged arteries.
Obviously, there’s more to heart-disease risk than cholesterol. And new research suggests that one hidden risk factor may be inflammation. Most of us know inflammation as the visible redness and swelling that shows up around a cut on the skin that has become infected. A similar process can happen inside the body. Low-level systemic inflammation, researchers suspect, may damage the lining of blood vessels, increasing the risk of plaque buildup and heart attacks.
Lately, more and more doctors have begun to test for inflammation by measuring a telltale marker, called C-reactive protein (CRP), in the blood. Studies show that people with the highest levels are twice as likely to develop heart disease or suffer a heart attack as those with the lowest CRP readings. Some experts now argue that CRP testing should be done routinely to identify people at risk who aren’t picked up by cholesterol screening.
What causes inflammation? No one knows. One guess is that the culprit is a viral or bacterial infection. Fortunately, both aspirin, statins and weight loss seem to reduce inflammation. There’s also evidence that being physically active may help keep inflammation in check.