The inflammation-heart disease connection

We hear the word “inflammation” quite a bit. By definition, the term refers to, “redness, swelling, pain, tenderness, heat, and disturbed function of an area of the body, especially as a reaction of tissues to injurious agents.” But one thing that remains vague is the correlation between this natural response from the body and the risk of cardiovascular disease. While the evidence is mounting, the answer might not be entirely clear just yet. Leah Felger, MSN, RN, program coordinator, Parkview Heart Institute, and Mark O’Shaughnessy, MD, PPG – Cardiology, tell us more.

A case study.
“Just recently I spent some time with my aunt right after she came out of our cath lab,” Leah shared. “She’d collapsed at work after not feeling well for a few weeks. She works in a fairly physical role, packing and loading boxes up to 60 lbs. onto trucks in a hot environment. She keeps her blood pressure under control, but has a long history of smoking. On that day, she was displaying the classic symptoms of a heart attack. Thankfully, her co-workers quickly recognized her distress and called 9-1-1.

Our conversation that day was pretty interesting. She would try to use a nicotine patch, but wasn’t thrilled. She immediately shot down cardiac rehab. ‘I can do that on my own,’ she said. ‘This was my wakeup call.’ She didn’t want to take cholesterol medicine. She didn’t think her diet was bad. But what really got me, was her reaction when I said, ‘You have heart disease.’ She was shocked. ‘I do?’

I see this all the time. Coming out of the cath lab, the physicians told her she had some blockage, but not enough to stent. What that means is that she has narrowing of her arteries and, because of that narrowing, her heart has been working harder and harder. So she’s been tired and worn out, short of breath, and not feeling well. But until she had this event ­– this wakeup call – and discovered that her arteries are narrowing, which is actually a hardening of the arteries known as Coronary Artery Disease, nothing got her attention. Which brings me to the topic of inflammation.

Inflammation is an inflammatory response to some sort of trauma. You skin your knee, you form a scab, it heals over, falls off, and you end up with a little scar. You get a mosquito bite, you get a nice red swollen itchy spot. You get a bee sting, it swells and burns. The same things can happen internally. In the case of my aunt, because of that hardening of her arteries, she ended up with chest pain because her heart was irritated from being over-stressed. You can imagine the same inflammatory response inside your body as the ones you see outside of it.”

The research.
A recent study featured in Circulation, the medical journal published by the American Heart Association, explored instances of chronic inflammatory disorders including psoriasis, GI disorders (such as ulcerative colitis and Crohn’s disease), inflammatory arthritis, auto-immune diseases and systemic vasculitis with instances of diabetes and cardiovascular disease.

“Several studies have suggested that chronic inflammation may be associated with a higher risk of heart disease as well as other diseases that are known to contribute to heart disease, such as type 2 diabetes,” Leah said. “When you think about these particular diseases collectively, you can see this inflammatory response creates irritation of some sort in each disease process.  This constant irritation results in damage at the cellular level and is ‘associated with vascular and metabolic changes that include endothelial dysfunction and insulin resistance, which may ultimately lead to cardiovascular disease’. Additional confounding factors, such as obesity and hypertension, were also noted, as they are related to specific inflammatory disorders and an increased risk in cardiovascular disease.”

The current stance.
Certainly the study mentioned above, as well as others, support an association between cardiovascular disease and a wide range of inflammatory conditions. The authors here are careful to note, however, that increased risk does not imply cause and effect. “Look at my aunt,” Leah said. “She is active, maintains a healthy weight and manages her blood pressure appropriately, but she has a long term history of smoking. Despite what we know, it’s impossible to say that one thing alone actually caused her heart event and coronary artery disease.”

So, can we say that inflammation causes cardiovascular disease?

“Basically, we believe inflammation plays a role in the development of cardiovascular disease,” Dr. O’Shaughnessy said, “but we do not know how or why. We think that chronic systemic inflammatory illnesses may play a role as well, but again, we do not know how or why. This gets into the chicken-or-the-egg issue. In short, we simply don't have a clue.”

Prevention.
While additional factors like increased psychosocial stress, reduced physical activity associated with chronic inflammatory disease, and the possible side effects of prescribed therapies including anti-inflammatory drugs are also contributing factors, prevention often comes back to the tried-and-true techniques.

“Inflammatory disorders often cause symptoms that become the larger focus,” Leah said. “If you can get those symptoms under control the prevention and diet recommendations are going to be the same that we always promote: being active, managing stress, maintaining a healthy weight and not smoking. There is no magic ticket.”

Leah explains that It is also unclear if an anti-inflammatory diet will help decrease an individual’s risk of developing heart disease or decrease the severity of a cardiac condition, but an overall wellness plan is always a good idea. “Patients with chronic inflammatory disorders should consider prevention of cardiovascular disease a higher priority,” Leah said. “They should seek to maintain a healthy lifestyle that includes not smoking, maintaining an active physical routine, knowing your numbers (cholesterol, blood pressure and glucose), keep weight in a healthy range, eat a healthy diet and decrease stress.”

 

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