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 202-877-3627 to talk to a doctor about how your sleep and exercise routine affects your heart.

 

What to expect during pregnancy if you have a heart condition

Common tests during pregnancy include ultrasounds and blood sugar screenings. But heart tests – such as electrocardiograms (EKGs) – are also sometimes necessary.

Obstetricians discuss and evaluate their pregnant patients’ heart health to gain knowledge of a woman’s family history and risk factors. In cases of prior heart problems, we need to take special care to manage heart health during pregnancy.

As little as 15 years ago, a woman with a condition such as a congenital heart defect would have been advised to never get pregnant. We just didn’t think her heart could handle pregnancy, labor and delivery. But thanks to advances in medicine, growing expertise and doctors from multiple specialties – and facilities – working together, more and more of these women are able to safely give birth.

I’ve cared for a woman who had a heart valve replacement when she was 26. She became pregnant and delivered a healthy baby a year later. There’s no getting around it, such pre-existing conditions add complications to a pregnancy. But in many cases, the staff and resources are available to care for these high-risk patients and help them plan for safe, healthy pregnancies and deliveries.

The January 2017 guidelines issued by the American Heart Association agree, recommending that women with serious congenital heart defects work closely with their cardiologist and maternal-fetal medicine specialist before, during and after pregnancy. The guidelines also recommend giving birth at a larger medical center with specialists who have the necessary expertise to manage such a delivery.

Planning for pregnancy with a heart condition

Before you become pregnant, sit down for a discussion with a cardiologist and a maternal-fetal medicine specialist. It’s important that everyone is aware of your health history and the potential risks involved.

We’ll also want to evaluate:

  • Medications: Some medications can harm a baby during pregnancy, so we’ll want to discuss changing a medication or adjusting the dosage.
  • Potential procedures: Certain conditions should be fixed before pregnancy. This could include repairing a hole in your heart or opening a blocked valve.
  • Genetics testing: This can determine your baby’s risk of inheriting a congenital heart defect.

Your family doctor or general obstetrician may not have the expertise to plan for or manage such a complex pregnancy. It takes a unique understanding to optimize the care and outcomes for these women.

We’ll help connect you with an experienced team through our Special Moms/Special Babies program, which offers coordinated care for moms with congenital health problems. We also partner with Children’s National Health System, with whom we share a campus, to care for pregnant women in their adult heart clinics.

Learn more about our Special Moms/Special Babies program or call 202-877-3627.

There are still some circumstances in which we may advise you to not become pregnant. If this is the case, talk to your doctor about reliable birth control options.

Managing a heart condition during pregnancy

Every pregnancy causes the heart to work overtime. For example, the amount of blood it pumps can increase by as much as 50 percent to sustain a growing baby.

Physical changes during pregnancy affect which stressors the maternal heart faces. And when an underlying cardiac problem is in play, we become more worried about the potential for heart failure, heart attack and pulmonary hypertension, among other things.

Your care team likely will include a maternal-fetal medicine specialist, obstetrician, cardiologist, neonatologist and other specialists as needed.

Together, we’ll help you manage your heart health with medication, diet and exercise. You’ll likely need regular tests such as blood tests and EKGs to evaluate your heart function.

And, of course, we’ll keep an eye on your baby. For example, we know that if mom has an arrhythmia, the baby can develop it as well, so we’ll monitor for that.

Going into labor and delivery

Your team will collaborate with you on a plan for labor and delivery based on your health. This will include deciding whether certain specialists need to be present, in which case we may plan to induce labor.

We’ll monitor your and your baby’s hearts throughout the process. Pushing can put additional stress on the heart, so we might limit how long you push, or give you additional assistance using forceps or a vacuum extractor. In some cases, a cesarean section may be necessary.

If you decide you would like to have another baby, talk with your cardiologist and maternal-fetal medicine specialist before you get pregnant again. Your heart health may have changed since your first pregnancy. And even if it hasn’t, every pregnancy is different. We want to prepare for all possibilities.

With proper planning and precautions, more and more women who thought they could never give birth due to a heart condition are realizing their dreams and taking home healthy babies.