A new study shows that inflammation may be as important as high cholesterol when it comes to preventing heart attacks (New England Journal of Medicine, Aug. 27, 2017). Researchers have known for years that statins work via two mechanisms…a cholesterol-lowering effect and anti-inflammatory action.
The Cholesterol Theory of Heart Disease:
When most health professionals think about the cause of heart disease they pin the tail on cholesterol. Drug treatment has focused almost exclusively on lowering cholesterol. That may soon change.
CANTOS (Canakinumab Antiinflammatory Thrombosis Outcome Study)
A large trial compared a unique anti-inflammatory medication called canakinumab (brand name Ilaris) to placebo. Three different doses of the medication were tested. The four-year study included 10,000 people who had had heart attacks. These people were at high risk for another heart attack. Would this unique anti-inflammatory medication prevent heart attacks?
Ilaris Is Already on the Market
The FDA has approved Ilaris to treat inflammatory rheumatological conditions such as juvenile idiopathic arthritis. It is also used to treat several rare inflammatory diseases.
Ilaris has not been approved for preventing heart attacks. It does NOT lower cholesterol levels.
The investigators report that volunteers on the two higher doses of canakinumab were about 15 percent less likely to have a heart attack or stroke. There was no difference between any of the groups with respect to mortality.
Why Is This Important?
The researchers point out that their trial was ground breaking because it demonstrated that reducing inflammation (without lowering cholesterol) could be helpful in preventing heart attacks. Here in doctorspeak are the researchers own words:
“CANTOS was designed to test directly the inflammatory hypothesis of atherothrombosis. In this trial, in patients with a history of myocardial infarction [heart attack], the levels of high-sensitivity C-reactive protein [a marker for inflammation] and interleukin-6 were significantly reduced from baseline by canakinumab, as compared with placebo, with no significant reduction in lipid levels from baseline…
“In conclusion, in CANTOS, patients with a history of myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter were randomly assigned to one of three doses of canakinumab or to placebo. Canakinumab significantly reduced high-sensitivity C-reactive protein levels from baseline, as compared with placebo, without reducing the LDL cholesterol level, and the 150-mg dose resulted in a significantly lower incidence of recurrent cardiovascular events than placebo.”
People’s Pharmacy Perspective:
We have long suspected that inflammation is at the root of most chronic health conditions. That includes heart disease, cancer, diabetes, lung conditions like asthma and COPD, and even Alzheimer’s disease.
Reducing inflammation through diet, exercise and anti-inflammatory supplements has always made sense to us. You can find a list of anti-inflammatory foods and other non-drug ways to fight inflammation in our Guide to Cholesterol Control & Heart Health.
The cost of Ilaris is breath taking. People in this trial got an injection every three months. When used to treat one of the rare inflammatory ailments, the cost per shot ranges from $14,000 to $23,000. Multiply that times four shots a year and you break the bank very quickly.
Because canakinumab works by dampening the immune system, it is associated with a greater risk for fatal infection. That may be why there was no overall reduction in mortality even though the drug was helpful in preventing heart attacks.
The Take Home Message:
We think reducing inflammation naturally makes total sense. That can be accomplished by not smoking, exercising regularly, eating anti-inflammatory foods and taking supplements that have anti-inflammatory activity. Learn more in our Guide to Cholesterol Control & Heart Health.
Listen to our one-hour interview with Dr. Dale Bredesen on The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline. In this FREE interview, Dr. Bredesen discusses inflammation and the brain and steps to help reduce inflammatory markers that may be as important for the brain as for the heart.
Here is a link: Show 1092: How Can You Overcome Alzheimer Disease?
The results of CANTOS were presented at the European Society of Cardiology and published in The New England Journal of Medicine.
[New England Journal of Medicine, online, Aug. 27, 2017]
Share your own thoughts about the role of inflammation in heart disease and other chronic conditions. What are you doing to reduce inflammation in your body? You can relate your experience in the comment section below.