Dr Harold Gunatillake

Until now, through the recognized biochemical tests available, it has been difficult to predict accurately the incidence of heart disease, strokes and other chronic vascular illnesses of people, other than by the early assessment of known risk factors in a blood sample, such as, checking on cholesterol, triglyceride, homo-cysteine levels, among others. A test called erythrocyte sedimentation rate (ESR) was the only known test to assess the progress of an illness, but not a marker to detect early disease. (A test to detect early bowel cancer, and other chronic bowel infections, “chorionic embryo antigen” (CEA) is considered a fairly accurate test that has stood the test of time).

All this vague knowledge that went into such assessments, on statistical study analysis, have been today revolutionized by one solitary test – checking your ‘C Reactive Protein’ (CRP) in a blood sample.

A news bulletin published by the American Heart Association, dated 20.08.2002,
States,” Using a simple inexpensive test to determine levels of C-reactive protein in the blood, researchers were able to detect heart disease before symptoms were apparent”.

The bulletin also stated that the Researchers studied the relationship between levels of
C-reactive protein (CRP, a marker inflammation in the body), and coronary calcium. (Calcium indicated the extent of atherosclerosis (fatty build up in the arteries), in the coronary arteries.

The study further revealed that while the majority of men and women had some calcium in their arteries, the higher the C-reactive protein level, the more calcium deposits were detected in the coronary arteries.

Dr Wang, one of the researchers said, “It has been known that inflammation plays a role in coronary artery disease but the direct link between the level of this marker of inflammation and the actual presence of calcium in the coronary arteries is a new

(Electron beam computorised tomography scans was used to detect the amount of calcium in coronary arteries).

Recent research shows that having a high C-Reactive Protein blood test means you are at increased risk of suffering a heart attack or stroke twice as much as having a high cholesterol, states Gabe Mirkin, M.D. So, in addition to a lipid check, adding this new test will be a more reliable marker to predict heart disease.

In medical school, we were taught that all diseases inflicted on the body, were broadly classified as congenital, inflammatory, degenerative, neo-plastic causes, among others. Today, besides congenital causes, most diseases affecting us seem to be caused from ‘Inflammation’. A good example is ‘Arthritis’. Once this was considered a degenerative disease, but today there is more evidence revealed to consider it as an inflammatory condition. This is why the anti-inflammatory drugs like cortisones; non-steroid anti-inflammatory drugs are effective in relieving the pain among arthritis sufferers. Aspirin, though not that popular is one of the best anti-inflammatory drugs, and very effective in relieving arthritic pain. Inflammation in arthritis is part of the pathology (disease process), unlike in other inflammatory situations; it is a response to some sort of injury.

So what is inflammation? It is the body response to injury of any sort- accidental trauma, from bacteria, viruses, fungi, parasitic, lack of vitamins, among others. It is an important finding that athero-sclerosis, which is thickening of blood vessels with atheromatous plaques (fatty deposits accumulation), leading to blockage of vessels begins as an inflammatory reaction.

So let us discuss in more detail about the inflammatory process occurring in the inner lining (intima) of the blood vessels in athero-sclerosis, leading to blockage with fatty deposits resulting in heart disease and strokes.

Inflammation causes redness, pain and swelling. These findings are visible in the inner lining of blood vessels in early athero-sclerosis. Linus Pauling, a chemist, two time Nobel laureate, and the world’s foremost vitamin C proponent, observed that the inflammatory picture seen in the inner lining of blood vessels during early athero-sclerosis was similar to what one would see in vessels due to vitamin C deficiency. This author is of opinion that the “scurvy like” inflammatory picture found in early atherosclerosis is due to lack of vitamin C in the body.

Think of the turbulence and mechanical stress caused by the highly pressured blood flow occurring in the major blood vessels continuously during one’s lifetime. This turbulence occurs at specific sites like in the arch of the aorta, and its branches in the shoulder and neck regions, and at bifurcations of major vessels. Such turbulences crack the inner lining of the blood vessels at specific sites. Linus Pauling observed that the atherosclerotic plaques do not form randomly through out the blood vessels. At postmortems it is observed that atheromatous plaques are found at specific sites common to all cases.

These cracks cause the inflammation resulting in fatty deposits seen at specific sites in the vessels. So presently, the current thought is that low-density cholesterol (LDL) is not the culprit, though it forms the bulk of the plaque. It is considered as a bystander

At this stage C Reactive Protein, an acute stage reactant is formed in the liver in response to systemic inflammation. In real terms this response is observed due to the inflammatory cells, and macrophages (scavenging cells), present at the sites of plaque formation.

It’s been suggested that testing CRP levels in the blood may be a new way to assess cardiovascular disease risk. A highly sensitive CRP test is now available in most countries. It is a very popular test done annually in the States, and in Australia.

C Reactive Protein levels fluctuate from day to day, and levels increase with aging, high blood pressure, alcohol use, smoking, lack of physical activities, increased coffee consumption, having elevated triglycerides, insulin resistance and diabetes, arthritis, chronic infections, taking the contraceptive pill, and depression.

So, it appears that C-reactive protein is a non-specific test and does not predict a definite marker for only cardio-vascular episodes.

It is noted that if the CRP level is lower than 1.0mg/L. a person has a low risk of developing cardio-vascular disease. It is more likely such low levels may be due to the other causes mentioned.

If however, the CRP is between 1.0 and 3.0mg/L, a person has an average “not to worry” risk.

If CRP is higher than 3.0mg/L a person is at high risk. (Normal ranges of CRP will vary from lab to lab).

If after repeated testing, patients have persistently unexplained, markedly elevated CRP (greater than 10.0mg/L), other evaluation should be considered to exclude non-cardiovascular causes.

In most individuals, the CRP may be elevated due to low-grade inflammations. The older generations would remember that the dentist would suggest removal of all teeth, if one suffers from ‘pyorrhea’. This was a chronic disease of the gums, with offensive discharges. The reason attributed for this drastic step was to prevent heart disease. I could not correlate and understand this relationship between chronic infection and heart disease, when I was a medical student or later until I read about CRP.

Today, we understand the rationale.
It is the low- grade inflammation that seems to put otherwise healthy people at risk.

However, the new findings are consistent with the hypothesis that an infection- possibly one caused by bacteria or virus- invariably will contribute to or even cause atherosclerosis.

So today, we can understand why chronic low-grade inflammations such as among diabetics, those suffering from low immune deficiency diseases, obesity, chronic lung diseases, neglected septic teeth, among others, end with up early atherosclerosis and heart disease. Checking your CRP level is very important to assess these situations.

At this time the best way we know to reduce C-Reactive Protein, when specific causes are not known, would be exercise, and a diet that includes omega-3 fatty acids, and eating plenty of fruits containing anti-oxidants. ‘Statins’, more than bringing the cholesterol level down, appear to protect against inflammation. (Remember statins can cause nerve and muscle damage and deplete the body of co-enzyme Q10). They rarely affect your liver and kidney functions. Check with your doctor for these side effects regularly- every three months. Co-enzyme Q10 is available today in pharmacies and health food shops, and it is advisable to be on it, if you are on large dose statins.

There is a sure way to bring down your cholesterol level without statins, by daily indulging in Gym workouts. Give it a go- the results will give you a new lease of long life. A medical examination by your doctor may be necessary before you venture.