February was heart month, and this is the last column in a series about the major risk factors for heart attacks. Heart attacks are not all about cholesterol—inflammation plays a large role. There are two types of inflammation: acute, which can be beneficial or harmful; and chronic, which is always harmful.

Acute inflammation occurs after an injury, is manifested by swelling and redness, and plays an important role in the healing process. However, occasionally acute inflammation can lead to harm, such as causing atherosclerotic plaque to rupture, resulting in heart attacks and strokes. For example, eighty to 100,000 heart attacks occur annually in the U.S. due to heart attacks caused by acute inflammation from influenza.

Chronic inflammation is always harmful. It contributes both to formation of arterial plaque and to plaque rupture. Causes of chronic inflammation include obesity; hypertension; high cholesterol; prediabetes; diabetes; tobacco; too little exercise; too much exercise; sleep apnea; stress; chronic tooth and gum disease; unhealthy diet; and inflammatory bowel disease as well as other inflammatory diseases such as rheumatoid arthritis and asthma.

 The Bale-Doneen method of heart attack prevention is recognized nationally and internationally as an exceptionally effective program. It involves the following:

• Determining if a patient has atherosclerosis (hardening of the arteries) through studies such as coronary calcium scoring or preferably carotid IMT.
• For those proven to have atherosclerosis, their provider should look for and treat the inflammation that caused the plaque to form.
• Their provider should also do detective work to find and reverse inflammation that can cause plaque to rupture.

Following are blood tests that determine if someone has vascular inflammation — “fire in your arteries” as Drs. Bale and Doneen call it:

• hsCRP (highly sensitive C-reactive protein) measures inflammation, but is non-specific—elevation can be due to arterial inflammation but also infections, arthritis, or even a hard workout.
• F2-isoprostane is elevated in people with an unhealthy lifestyle, and Bale and Doneen call it the “lifestyle lie detector test.” It is also elevated in over-exercisers such as ultra-marathoners and people who run repeated marathons—because excessive exercise causes oxidative stress and inflammation.
• Microalbumin/creatinine ratio is a urine test that measures inflammation of the endothelial lining of arteries in the kidneys—which are very vascular organs. Men with a value of over 4 and women with a value of over 7.5 are at triple the risk for a heart attack or stroke.
• Lp-PLA2 is an FDA-approved test which if elevated is a marker of arterial wall inflammation and also a marker of likelihood of plaque rupture. People with elevation of this enzyme are twice as likely to suffer a heart attack. Elevation of Lp-PLA2 is often driven by chronic tooth and/or gum disease, which should be looked for because treatment decreases levels of this enzyme, thereby decreasing risk of heart attacks and strokes.
• The FDA-approved test myeloperoxidase (MPO), when elevated, is the most dangerous of the vascular inflammatory markers. Dental infections are often the cause of elevation, and treatment can bring down levels and risk.

A panel of all these tests is available through Boston Heart Diagnostics, Cleveland HeartLab, Quest Diagnostics, and LabCorp for under $150 and is covered by Medicare and most insurances.

In summary, diagnosis and treatment of vascular inflammation is imperative in prevention heart attacks and strokes.  Consider coronary calcium score or a carotid IMT (both available locally at Compass Peak Imaging) to assess the health of your arteries. If your arteries are diseased, consider the aforementioned blood tests (should be fasting at least 6 hours) at a facility that knows what to draw and where to send it. If the results indicate vascular inflammation, consider the following:

• See a dentist who understands the mouth-vascular connection. They will want to order a mouth microbiome analysis, looking for dangerous bacteria, treatment of which can lower risk for heart attacks.
• Optimize your diet: Animal products, processed foods and oil cause inflammation; a plant-based whole food diet is anti-inflammatory.
• Get at least 30 minutes of exercise daily but don’t overdo it.
• Statins are anti-inflammatory, and Bale and Doneen feel that anyone proven to have plaque should be on a statin, no matter what their cholesterol is.

Dr. Greg Feinsinger is a retired family physician who started the non-profit Center For Prevention and Treatment of Disease Through Nutrition. For questions or to schedule a free consultation about nutrition or heart attack prevention contact him at gfmd41@gmail.com or 970-379-5718.