TEN YEARS AGO, A STUDY in the New England Journal of Medicine created a lot of buzz about the idea of battling high levels of heart inflammation that can lead to heart problems with the cholesterol-lowering drug Crestor. The study found that the statin lowered the risk of heart attacks and strokes in people with normal cholesterol but high levels of inflammation, which were measured by a marker called C-reactive protein, or CRP. The Jupiter study involved nearly 18,000 men age 50 and older and women age 60 and above. The research found that people taking the medication for two to five years reduced their risk of suffering a heart attack or stroke during that period by 50 percent.
Some experts at the time predicted that as a result of the study, millions of apparently healthy people would be screened for heart inflammation with a blood test called high-sensitivity C-reactive protein, and that many of these people would be put on statins to combat heart inflammation. That prediction turned out to be overstated, which is a good thing, says Dr. David Becker, director of the Preventive and Integrative Heart Health Program at the Temple Heart & Vascular Institute. He’s also the head of preventive cardiology at Temple University Hospital in Philadelphia. “That really hasn’t happened, and I’m glad to see that,” Becker says. That’s because the people in the Jupiter trial were as a group fairly sedentary and didn’t exercise much, he says. For many people who fit that profile, the better approach to ward off heart disease is to exercise more and adopt a Mediterranean diet, Becker says.
How to Prevent Heart Inflammation
Dr. Nieca Goldberg agrees that making lifestyle changes, rather than just taking a statin, is a better approach for most people. She’s the medical director of the Joan H. Tisch Center for Women’s Health at NYU Langone in New York City. Taking a statin to reduce the risk of a heart attack or other cardio problems could be helpful for some patients, Goldberg says, but she cautions that the Jupiter study wouldn’t be relevant to patients outside the age groups researchers studied. The high-sensitivity C-reactive protein test could be beneficial for certain patients, like someone who has cholesterol that appears to be at a normal level but may have a history of heart disease, she says. The CRP screening test can also be helpful in motivating some people to make lifestyle changes that could lower their heart inflammation levels without medication, she says. Experts are split on whether to recommend statins for people without a history of cardiovascular disease. A study published in April 2017 in the Journal of the American Medical Association found that the U.S. Preventive Services Task Force recommendation for adults between the ages of 40 and 75 would cover a little more than 17 million U.S. residents. Four years earlier, the American College of Cardiology and the American Heart Association released guidelines recommending that 33 million Americans without cardiovascular disease who have a 7.5 percent or higher risk for a heart attack or a stroke within 10 years have statin therapy. “The most recent recommendations from the ACC/AHA, in my opinion, overestimate the number of people with no known heart disease who should be taking statins,” Becker says. “I would like to see more people begin a plant-based diet and an exercise regimen before running to take a statin. It’s a little bit harder to exercise and diet than to take a pill, but you get more bang for your buck.”
Fortunately, there’s no confusion about the fact that there are several effective strategies for warding off inflammation of the heart that don’t involve taking medication, Becker says. Experts recommend these approaches:
1. Don’t smoke. Tobacco smoke is probably the single most significant source of toxic chemical exposure to humans, says Dr. Kavitha Chinnaiyan, a cardiologist at Beaumont Hospital in Royal Oak, Michigan. Smoking is a risk factor for cardiovascular disease, as it hardens the arteries and could raise CRP levels. “Smoking affects systemic inflammation by activating and releasing inflammatory cells into the circulation,” Chinnaiyan says. “When we stop smoking, we prevent the ingestion of various toxins present in cigarette smoke from causing inflammation and other toxic exposure to the organs. Nicotine in and of itself is a risk factor for inflammation and heart disease. Heart disease and other chronic illnesses are inflammatory diseases that create blockages in the coronary and other arteries.”
2. Consume a Mediterranean diet. Research published in the New England Journal of Medicine in 2013 suggests that eating a Mediterranean diet supplemented with extra-virgin olive oil or nuts “reduced the incidence of major cardiovascular events” among people at high risk for heart problems. The traditional Mediterranean diet includes lots of olive oil, fruit, nuts, vegetables, whole grains, beans and legumes. It calls for eating moderate amounts of fish, seafood, poultry, eggs and cheese. A Mediterranean diet eschews foods that cause inflammation, such as processed and fried foods and refined carbohydrates, including sugar. Eating foods that are part of the Mediterranean diet can help reduce the risk of heart inflammation.
3. Exercise regularly. You can lower heart inflammation without medication and improve your overall health by exercising regularly, Becker says. He recommends some kind of aerobic exercise 30 to 45 minutes a day, as many days of the week as you can. “You don’t have to run a marathon,” he says. “Any kind of movement helps. Standing is better than sitting. Walking is better than standing. Jogging is better than walking, Any kind of exercise is beneficial.” Research published in the Journal of the American College of Cardiology in March 2018 suggests that sustained physical activity is associated with a substantial reduction in the risk of mortality among people with coronary heart disease. Regular exercise is also helpful in warding off chronic conditions like diabetes, depression and obesity.
4. Drop inches around your middle. Many of us gain weight as we get older, and carrying extra pounds is a risk factor for inflammation that could lead to heart disease, Becker says. As they age, men tend to put on pounds around their belly, while women often put on extra weight about their hips, he says. Men who have a waist measurement of 40 inches or more and women with a waist circumference of 35 inches or more are at risk of high inflammation. Losing weight by exercising more and eating a healthy diet, like the Mediterranean regimen, can reduce your risk of heart inflammation, he says.
5. Get plenty of sleep. Many people overlook the important role sleep plays in preventing heart inflammation, says Dr. Joel Kahn, a cardiologist based in Detroit. Research suggests that people who don’t get enough sleep have an increased risk of cardiovascular disease and coronary heart disease, Kahn says. People who have poor sleep quality are particularly at risk for cardiovascular and coronary disease. To prevent heart inflammation, get at least seven to eight hours of quality sleep a night, he says.
6. Lower your stress. When your body is under high levels of stress, it releases the hormone cortisol, which is a risk factor for heart inflammation, Goldberg says. Goldberg recommends a host of approaches for reducing stress, including exercise, relaxed breathing techniques, yoga and meditation. “Reducing overall stress is good for the heart,” she says.