Know your heart-healthy numbers – including CRP

“Know your numbers.” It’s a common theme surrounding heart health. Most doctors agree you should know your blood pressure, blood sugar and cholesterol so you can make changes to improve your health and reduce your risk of heart problems.

But there’s one more number people should be aware of: C-reactive protein (CRP).

CRP is a marker for inflammation in the body. It’s been shown that, when used in conjunction with cholesterol levels, it can help us better understand a person’s risk for heart disease. In fact, one analysis showed that the risk of a future heart event was more than 50 percent higher when CRP levels were over 3 mg/L.

Unfortunately, people often emphasize their cholesterol levels without considering any other factors. They think if their cholesterol is low, they are at low risk for heart disease. That may not always be the case. Knowing both your CRP and cholesterol levels is more powerful than knowing one alone.

Let’s take a closer look at how your CRP affects your heart risk. That way, the next time your doctor prepares to test your cholesterol, you can also ask about your CRP level.

What is CRP, and what does it tell us about heart health?

CRP is a ring-shaped protein produced in the liver in response to inflammation in the body. Inflammation is part of the body’s response to fighting infection. We all have a low level of inflammation at any given time. That’s normal and healthy.

While the exact role inflammation plays in heart disease is a topic of ongoing research, we do know that having a high level of inflammation over a long period of time creates heart risk. And we know we can measure inflammation in the body by testing CRP levels.

Checking your CRP involves a simple blood test. If you’re getting your cholesterol tested, we can use the same tube of blood. No extra needle sticks are necessary.

Your CRP level puts you in one of three categories:

  • Low risk: Less than 1 mg/L
  • Average risk: 1 to 3 mg/L
  • High risk: Greater than 3 mg/L

However, your CRP can’t tell us everything. It’s important to look at it in relation to your cholesterol, specifically low-density lipoprotein (LDL). LDL is considered the bad cholesterol because it collects in your arteries and can cause blockages. Your CRP modifies your LDL level.

Here’s how it works: If you have a low LDL but a high CRP, the high CRP reduces the benefit of a low LDL. You’re at increased risk. And it’s the same in reverse: If you have a high LDL but a very low CRP, that low CRP reduces the risk from the high LDL.

In fact, the American Heart Association and the Centers for Disease Control and Prevention say it’s reasonable to measure CRP as a part of heart disease risk assessment. It’s not considered mandatory, but patients and their doctors should discuss its potential benefits.

Once you know your numbers, there is a very simple online scoring tool you can use to predict your heart risk over the next 10 years.

How can you lower your CRP?

What causes a high CRP? It’s a combination of genetics, health and lifestyle factors, including:

  • Chronic inflammatory conditions such as rheumatoid arthritis, lupus, psoriasis and gum disease
  • Excess body fat
  • Low physical activity
  • Smoking

The good news is that there are many ways to lower your CRP. Most are the same things you should be doing to live a heart-healthy lifestyle: eat a healthy diet, exercise and quit smoking. If you have a chronic inflammatory condition, work with your doctor to manage it effectively.

Studies, including one I authored, have shown statins also can reduce CRP. Statins are a class of drugs typically prescribed to lower cholesterol levels and reduce the risk of heart attack and stroke. Current guidelines advise the use of statins for people with:

  • Known heart disease
  • Elevated levels of LDL cholesterol
  • Diabetes
  • An estimated 10-year risk of a heart event greater than 7.5 percent

And the JUPITER study showed statins could benefit otherwise healthy people with high CRP levels by cutting their risk of heart disease and death from heart disease by almost half. This would indicate we should take CRP into effect when assessing a person’s heart risk.

Who should get their CRP tested?

I recommend anyone who has their cholesterol checked to also have their CRP tested. As I said earlier, we can use the same blood draw; we simply check one more box for the lab to test.

Just like with cholesterol, the earlier we identify a high CRP levels, the more time we have to prevent potential heart problems through lifestyle changes and, if necessary, medical treatments.

CRP is simply one more way to optimize our understanding of someone’s heart risk. And high CRP is treatable! So the next time you’re in the doctor’s office, ask about your numbers. All of them.

Request an appointment to test your heart-health numbers.

The surprising heart risks of too much sleep and exercise

You’ve probably heard a lot about how getting exercise and sleep can help you avoid heart troubles in the future. But getting too much of either can actually increase your risk of heart disease.

It seems counterintuitive. After all, we’re constantly told that exercising regularly and getting enough sleep are vital to staving off obesity, high blood pressure, stroke and, of course, heart disease. And it’s true. Exercise and sleep are important components of a healthy lifestyle. So, wouldn’t exercising even more and getting lots of sleep make us healthier and less prone to heart disease?

Surprisingly, the answer is no. Excessive sleep and over-exercising can increase your risk for heart disease, just like not getting enough sleep or exercise can. In many disciplines, from economics to communication, this phenomenon is known as the “Goldilocks effect,” referring to the children’s story of “Goldilocks and the Three Bears.”

Here’s how can you balance your sleep and exercise to find the amount that isn’t too much or too little, but instead “just right” for your heart health.     

How sleep affects the heart

There is still some debate about the exact amount of sleep that’s ideal for adults. However, researchers have reached a consensus on the optimum range. Almost everyone needs between seven and nine hours of sleep every day. And no, you can’t “catch up” on the weekends. It’s much better for your body’s circadian rhythm–the natural sleeping and waking cycle–to go to bed and wake up at a relatively consistent time each day.

Some people are naturally long sleepers, about two percent of the population. These people need 10 to 12 hours of sleep, or they feel tired and groggy throughout the day. However, most people should not be sleeping more than nine hours per day.  

Oversleeping has been linked to increased inflammation–in which the body’s immune system attacks healthy tissue. Chronic inflammation, or inflammation that occurs over months or even years, can put you at greater risk for cancer, diabetes, heart disease and many other health problems.

Getting too little sleep or too much sleep can increase inflammation levels. But considering that fewer people are aware of the dangers of oversleeping compared to undersleeping, it’s important to emphasize that both can lead to heart problems in the future. A study of the National Health and Nutrition Examination Survey found that, compared to people who get six to eight hours of sleep, those who slept:

  • Less than six hours: Had a doubled risk of stroke or heart attack
  • More than eight hours: Had a doubled risk of angina – chest pain due to reduced blood flow – and 10 percent higher risk of coronary artery disease

If you’re having trouble getting between seven and nine hours of sleep each night, bring it up to your doctor at your next physical. While short-term sleep problems aren’t likely to cause lasting damage, developing poor sleep habits can put you at higher risk for heart trouble as well as other problems later in life.

How exercise affects the heart

On the whole, Americans don’t exercise nearly enough. About half of U.S. adults don’t get enough aerobic physical activity – the heart-strengthening exercises known as “cardio.” Aerobic exercise is one of the best ways to safeguard against future heart disease and improve your overall health. However, too much vigorous aerobic exercise can also be detrimental to your heart health.

Like a few days of getting too little sleep, brief bouts of high-intensity cardio followed by periods of rest won’t do lasting damage. In fact, it can make your heart stronger. Problems arise when extreme athletes – such as long-distance runners, rowers, swimmers and cyclists – perform vigorous exercise regularly.

Intense aerobic physical activity puts a strain on your heart. Over time, repeated strain changes the very structure of the heart, enlarging the arteries and right ventricle and causing thick scar tissue to form in the heart’s two atria. These adaptations have been linked to heart problems in some people, though more research is needed for us to draw definitive conclusions.

There are many misconceptions about how intense exercise needs to be to achieve the best results. I find that many people believe they have to be totally out of breath and drenched in sweat to get a “good workout,” but the reality is that, as far as your heart is concerned, you’ll maximize your exercise benefits with regular moderate exercise, like a brisk walk. What defines “moderate” exercise? You should sweat a little and be able to carry on a conversation with someone without too much difficulty.

The American Heart Association recommends 150 minutes of moderate physical activity per week, or 75 minutes of vigorous exercise, or some combination of both. I suggest doing 30 to 60 minutes of moderate exercise on most days of the week. That’s a healthy habit that you can continue through your whole life. 

This doesn’t mean you shouldn’t give that marathon or triathlon you’ve always wanted to do a try. I’ve finished 11 marathons and a 50-mile race, so I know the allure of such events. The positives of endurance training are many: fitness, strength, even psychological. But we need to remember that more isn’t always better. Talk to your doctor before beginning to train for such endurance events. As for me, I still enjoy running and believe strongly in the benefits of exercise, although I’ve moderated my distance over the years, opting for a morning jog on the C&O canal as my favorite run!

Most people don’t have to worry about exercising too much or oversleeping. In fact, they should be concerned about too little exercise and sleep! But for extreme athletes and chronic sleepers, these issues can lead to heart problems in the future. The trick to the Goldilocks effect of sleep and exercise is finding a balance that makes you feel “just right.”

 

Request an appointment online or call 844-333-DOCS to talk to a doctor about how your sleep and exercise routine affects your heart.