Health Rounds: Inflammation may lead to serious heart issues for women without other risk factors

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By Nancy Lapid

(Reuters) -Inflammation may help explain why heart attacks and strokes occur in women who do not have any of the usual risk factors, researchers say.

Women who suffer heart attacks or strokes often have none of what are thought to be the main risk factors for major cardiovascular events such as high blood pressure, high cholesterol, diabetes, and smoking, researchers said in Madrid at a meeting of the European Society of Cardiology.

For three decades, they tracked 12,530 initially healthy women without any of the traditional risk factors, according to a report of the study published in the European Heart Journal.

The women who started the study with elevated levels of an inflammation marker called C-reactive protein, or CRP, as measured by a high sensitivity test, had a 77% increased lifetime risk of coronary heart disease, a 39% increased lifetime risk of stroke, and a 52% increased lifetime risk of any major cardiovascular event compared to women with lower CRP.

High levels on the high sensitivity test were defined as greater than 3 milligrams per liter of blood.

An observational study like this one can’t prove inflammation caused the cardiovascular events. It is well known, however, that over time, even low levels of inflammation can promote growth of plaques in arteries, loosen those plaques and trigger the blood clots that are the primary causes of heart attacks and strokes.

“Our data clearly show that apparently healthy women who are inflamed are at substantial lifetime risk,” study leader Dr. Paul Ridker of Mass General Brigham’s Heart and Vascular Institute said in a statement.

“We should be identifying these women in their 40s, at a time when they can initiate preventive care, not wait for the disease to establish itself in their 70s, when it is often too late to make a real difference,” he said.

Looking back at data from earlier randomized trials, his team also found that statin drugs can cut the risk of heart attack and stroke by more than one-third for women with inflammation who don’t have the usual cardiovascular risk factors.

“While those with inflammation should aggressively initiate lifestyle and behavioral preventive efforts, statin therapy could also play an important role in helping reduce risk among these individuals,” Ridker said.

NOVARTIS DRUG BRINGS DOWN DANGEROUSLY HIGH CHOLESTEROL

An injectable Novartis drug helped patients who had not responded to optimized medical therapy reduce dangerously high cholesterol to target levels, according to data from a clinical trial.

At 133 medical centers in Europe, 1,770 such patients were randomly assigned to receive subcutaneous injections of Leqvio or a placebo twice a year, along with maximally tolerated oral medications, such as statins.

At 90 days, 84.9% of patients in the Leqvio arm and 31% in the placebo group had achieved their individual guideline-recommended levels of LDL, or bad cholesterol, researchers reported at the ESC meeting in Madrid and in the European Heart Journal.

At roughly one year, LDL levels had fallen by an average of 59.5% with Leqvio compared with 24.3% for those not getting the Novartis drug.

Rates of muscle-related adverse events were lower with Leqvio, at 11.9% versus 19.2% for the placebo group.

Leqvio is the brand name for inclisiran, which is given every six months and works by blocking production of a protein in the liver called PCSK9. Without this protein, the liver can more effectively remove LDL cholesterol from the blood.

Other approved medicines that target PCSK9, such as Amgen’s Repatha, have a different mechanism of action.

“Inclisiran represents a convenient, effective and well-tolerated treatment option for the high number of at-risk patients who currently do not respond adequately to other lipid-lowering therapies,” study leader Professor Ulf Landmesser from the Deutsches Herzzentrum der Charite in Berlin said in a statement.

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(Reporting by Nancy Lapid; Editing by Bill Berkrot)