Ronald Grisanti D.C., D.A.B.C.O., M.S.

Imagine driving down the road and following a red Ford Mini-Van down the highway. You are going on vacation to Disney World and you have decided to follow a good friend and there family to the home of Mickey Mouse.

Seven hours into the trip and half way there, you get this look of horror when you realize you had been following the wrong Ford Mini-Van. Well, I must say.. it is about time people stop chasing their cholesterol levels and start looking at something that has been documented to be a major trigger of heart attacks.

If you are one of the millions of people who like that person following the red Mini Van has been tracking their cholesterol, you may be in for a rude awakening.

You have likely been following the wrong thing and may very well end up some place you don't want to be (in the hospital) or worse yet in the morgue. If I said it once I will say it again.. stop using your cholesterol as a marker of good heart health.

Finally, an extensive research study conducted by Dr. Paul Ridker, a cardiologist at Brigham and Women's Hospital suggests that measuring your C-Reactive Protein is more important than cholesterol at triggering heart attacks.

C-Reactive Protein is a simple blood test that measures inflammation in the body. High amounts of this protein may predict your risk of getting a heart attack or stroke years before it may occur.. even when cholesterol levels are low.

According to Dr. Ridker, "there is finally a way of targeting and preventing heart disease that was essentially missed because of our focus solely on cholesterol."

Ridker also says..there are between 25 million and 35 million healthy middle-aged Americans with normal cholesterol but above average C-Reactive Protein putting them at an unusual risk of heart attacks and strokes.

It has been a major concern for cardiologists on why half of all heart attack victims have normal or even low cholesterol. Clearly, something big was missing and now it appears the puzzle may have been solved. The answer is inflammation. In the past year or two, experts say, the evidence has been overwhelming that inflammation hidden deep in the body is a common trigger of heart attacks, even when clogging in the arteries is minimal.

New federal recommendations are being written that will urge all doctors to test millions of middle-aged Americans for high levels of C-Reactive Protein.

Dr. Grisanti's Comments:

I am overwhelmed with the amount of medical research documenting the significance of elevated C-Reactive Protein and heart attacks and strokes. I find it unacceptable for any patient with even the slightest hint of heart disease not to be tested for C-Reactive Protein. Matter of fact, I encourage every individual over the age of 35 to insist that their physician test the levels of C-Reactive Protein as part of a comprehensive blood profile.

To discount the importance of this test by your physician clearly shows a physician who is not staying abreast of the medical literature. As you will note below under my references, most of the medical abstracts are within the last two years with five all this year (2002).

Testing for C-Reactive Protein has been part of my standard but comprehensive blood profile for the last five years. Unfortunately, most physicians must be convinced that a test is absolutely necessary before they make it part of their basic blood profile. Although, I agree that testing for every new lab test would be cost-inhibitive, I do not understand why a physician faced with the avalanche of medical research documenting the major importance of C-Reactive Protein still tends to ignore this life-saving test.

How many people are going to die or suffer the permanent effects of a stroke before all physicians make this test part of their standard cardiovascular assessment?!

The review of medical records including blood tests from my last 10 patients DID NOT include a C-Reactive Protein. I discovered four patients that required immediate cardiovascular consults due to an overlooked diagnosis of arteriosclerosis. All this was accomplished by me ordering a C-Reactive Protein. Of interest.. all four of these patients had cholesterol values below 190 with one slightly above 200..however, all had significant elevations of the C-Reactive Protein

References:

1: Sakkinen P, Abbott RD, Curb JD, Rodriguez BL, Yano K, Tracy RP. C-reactive protein and myocardial infarction. J Clin Epidemiol. 2002 May;55(5):445-51.

2: Zee RY, Ridker PM. Polymorphism in the human C-reactive protein (CRP) gene, plasma concentrations of CRP, and the risk of future arterial thrombosis. Atherosclerosis. 2002 May;162(1):217-9.

3: Link A, Bohm M, Nickenig G. [Acute coronary syndrome--better risk stratification by determination of inflammatory parameters?] Med Klin. 2002 Feb 15;97(2):63-9.

4: Retterstol L, Eikvar L, Bohn M, Bakken A, Erikssen J, Berg K. C-reactive protein predicts death in patients with previous premature myocardial infarction--a 10 year follow-up study. Atherosclerosis. 2002 Feb;160(2):433-40.

5: Blake GJ, Ridker PM, Kuntz KM. Projected life-expectancy gains with statin therapy for individuals with elevated C-reactive protein levels. J Am Coll Cardiol. 2002 Jul 3;40(1):49-55.

6: Ridker PM, Glynn RJ, Hennekens CH. C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first myocardial infarction. Circulation. 1998 May 26;97(20):2007-11.

7: Pepys MB, Hirschfield GM. C-reactive protein and its role in the pathogenesis of myocardial infarction. Ital Heart J. 2001 Nov;2(11):804-6.

8: Koenig W, Torzewski J. C-reactive protein and atherosclerosis: quo vadis? Ital Heart J. 2001 Nov;2(11):801-3.

9: Morrow DA, Ridker PM. C-reactive protein, inflammation, and coronary risk. Med Clin North Am. 2000 Jan;84(1):149-61

10: Koenig W. C-reactive protein: risk assessment in the primary prevention of atherosclerotic disease. Has the time come for including it in the risk profile? Ital Heart J. 2001 Mar;2(3):157-63.

11: Jialal I, Devaraj S. Inflammation and atherosclerosis: the value of the high-sensitivity C-reactive protein assay as a risk marker. Am J Clin Pathol. 2001 Dec;116 Suppl:S108-15.

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