Options beyond statins

November 17, 2008 at 2:15 pm | Posted in health care, medicine | Leave a comment
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There is, they said, sound evidence that exercise and a healthy diet can lower levels of inflammation as measured by the high-sensitivity C-reactive protein test, known as hs-CRP. But – and this is where it gets a bit tricky – it has yet to be proved beyond a doubt that patients who reduce their inflammation levels through lifestyle changes have fewer cardiovascular emergencies.

Still, when Dr. Paul Ridker tells patients they have scored dangerously high on the test he created, this is his recommendation:

“The first, second, third, and fourth intervention for anyone with elevated hs-CRP is get to the gym, lose a few pounds, throw away the cigarettes, and start thinking about a healthier diet,” Ridker said. “That remains overwhelmingly the most important intervention for lowering cardiovascular risk.”

Just how important? A 2006 study by University of Massachusetts Medical School researchers showed people with fiber-laden diets were 63 percent less likely to have inflammation problems than people whose diets were low in fiber. An Italian study had similar findings, saying patients who consumed lots of whole grains, fruits, vegetables, and nuts significantly reduced their inflammation readings.

Dr. Ira S. Ockene, a preventive cardiology specialist at UMass and an author of the fiber study, said 30 grams of fiber is considered the benchmark for a healthy diet. You can get as much as one-third of that, he said, by eating a hearty bowl of pea soup.

“And if you want to lower your CRP and you have a big gut,” he said, “the best thing to do is to exercise and lose weight. When you lose weight, a whole bunch of good things happen.”

While researchers long recognized that physical activity reduces risk of heart attacks and strokes, the underlying reasons were not always so clear. A Brigham study last year yielded important clues, finding that lower inflammation levels matter most.

It doesn’t take a lot of exercise, Ridker said: A half-hour a day of aerobic exercise will do.

“I take a fair number of patients who travel quite a bit, and I tell them, ‘It’s as important to put your sneakers in your briefcase as it is your laptop,’ ” Ridker said.

It makes a world of sense that exercise and diet should contribute to reducing inflammation and, by extension, heart attacks and stroke, said Dr. Michael Lauer, of the National Heart, Lung, and Blood Institute.

“But I have to be honest,” Lauer said, “this is a hypothesis at this time – and a very good hypothesis – but I don’t think it’s a proven one.” And it won’t be, he said, until a study demonstrates for sure that an inflammation-reducing lifestyle changes result in fewer heart attacks and strokes.

At Cleveland Clinic, doctors don’t just preach about exercise and diet; they take patients on outings to restaurants to reinforce good habits. Patients are asked to be honest about whether they’re likely to heed the advice to eat well and exercise.

For some patients, “pills are an answer, but it’s not all of the answer,” Cho said. “I tell my patients all the time that pills are supplements, not substitutes, for a healthy lifestyle.”


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