How you can have good cholesterol and still face double the risk of heart attack or stroke

A study published a couple of weeks ago looked at over 3000 patients with known heart disease, and stratified their outcomes according to their high sensitivity C-reactive protein levels (hsCRP), a measure of vascular inflammation.

What made the study especially interesting was that all of these individuals had LDL (bad) cholesterol levels below 70 mg/dL — meaning they were all “at goal” for cholesterol control and were on statin drugs.

What the investigators found was that even among individuals who would be deemed low risk based upon LDL cholesterol levels, those with elevated inflammation (high hsCRP) levels had double the risk of experiencing a subsequent cardiac event — such as heart attack, stroke, death, stent/angioplasty, or bypass surgery. A normal hsCRP level is below 2 mg/L. The high-risk individuals in this study had levels persistently above that point.

This study supports what we already know – that coronary and vascular disease is, in part, an inflammatory process…

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Missed opportunities

Abnormal levels of inflammatory markers (like hsCRP) indicate the presence of plaque that is less stable and more prone to causing out of the blue events like heart attack, stroke and cardiac death.

In fact, it is generally accepted that the reason statins reduce heart disease risk is as much related to their anti-inflammatory effects as it is to their cholesterol-lowering properties.

So, what’s the missed opportunity here?

It was the conclusion of the researchers.

They determined that what we should all be working diligently on is to develop and test more anti-inflammatory drugs! Yes, that’s an option. But how about addressing the root CAUSE of inflammation instead?

Some of the biggest contributors to inflammation inside your body are smoking, stress, and DIET. And the most pro-inflammatory foods?

  • Processed meats (think ham and bacon)
  • Sugary drinks
  • Trans fats
  • Processed grains (think white bread, white pasta)
  • Processed snack foods (think chips and crackers)
  • Desserts, such as cookies, candy, and ice cream

In other words, grocery items that are commonly found in most American’s grocery carts.  Excess alcohol can also be pro-inflammatory, which is one of the reasons why one serving of red wine might be protective for heart disease, but more is not necessarily better.

The investigators completely ignored all of these factors and moved straight to pharmaceuticals. Are we surprised?

Related: 6 ways to manage cholesterol without drugs or disease risk

This may sound odd coming from a Mayo Clinic and Johns Hopkins-trained cardiologist, but in my opinion, we jump to drugs too quickly.

Especially when we haven’t even begun to exhaust lifestyle options — especially the power of food.

So, what should you take away from this week’s blog?

  • That there’s more to heart disease than just a cholesterol number;
  • There are many contributors you have control over;
  • And that food affects everything. Which is why you should always make the best choice you can – one that is closest to the whole-food, plant-based ideal to lower the inflammation abomination.

If you need help getting started on foods that can help, Step One has you covered.

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Dr. Elizabeth Klodas MD, FACC

By Dr. Elizabeth Klodas MD, FACC

"Diet is a major driver of high cholesterol, but instead of changing the food, we prescribe medications. This never seemed logical to me.” Dr. Klodas has dedicated her career to preventive cardiology. Trained at Mayo Clinic and Johns Hopkins, she is the founder and Chief Medical Officer for Step One Foods. Dr. Klodas is a nationally sought out speaker and has an active role at the American College of Cardiology. Her clinical interests include prevention of heart disease and non-invasive cardiac imaging and she has published dozens of scientific articles throughout her career. Dr. Klodas has been featured on CNN Health for her mission to change how heart disease is treated. An independent study performed at leading medical institutions affirmed the ability of Step One Foods to deliver measurable and meaningful cholesterol-reduction benefits in the real world. The results of the trial were presented at the 2018 American Heart Association’s Scientific Sessions. Dr. Klodas has also authored a book for patients, "Slay the Giant: The Power of Prevention in Defeating Heart Disease," and served as founding Editor-in-Chief of the patient education effort of the American College of Cardiology. In addition to her practice and her duties at Step One Foods, she also serves as medical editor for webMD.