Heart attacks and strokes cause 50 percent of the deaths in North America today, yet many people are not adopting the lifestyle changes needed to prevent the factors that cause them: inflammation and clotting. A new study from the University of Michigan shows how important inflammation is as a cause of heart attacks and strokes (JCI, May 28, 2019). In this study, when mice formed clots in their blood vessels, they also had a rise in blood levels of interleukin-1 beta, a cytokine molecule that causes inflammation. Giving the mice an enzyme called CD39, which blocks inflammation by markedly reducing interleukin-1 beta, reduced the size and number of clots that formed in their bodies. Blocking the anti-inflammatory CD39 increased the number and size of clots.

CD39 is an enzyme found on the surface of white blood cells and the inner lining of blood vessels that inhibits inflammation. It is produced by humans, but its use in humans has not yet been tested and it is not an available treatment at this time.

What is Inflammation?
Your immune system is supposed to protect you. When you get an infection, your immune system produces white blood cells and chemicals that attack and kill germs. When you damage tissue, your immune system produces exactly the same white blood cells and chemicals and uses them to heal damaged tissue. As soon as your tissue is healed or the infection is gone, your immune system is supposed to dampen down. However, if your immune system stays on all the time, it can attack your healthy tissue in the same way that it attacks invading germs or injuries. This is called inflammation.

Many studies show that inflammation (an overactive immune system) can cause the clots that cause heart attacks and strokes. Heart attacks are not caused by narrowed arteries. Heart attacks are caused by a plaque breaking off from an artery, followed by bleeding and clotting. Then the clot extends to completely block blood flow to a part of the heart muscle. Inflammation, which is supposed to punch holes in the membranes of attacking germs, also punches holes in the inner linings of arteries to cause plaques to form and then knocks off plaques to cause the bleeding and clotting that leads to a heart attack.

Reducing Inflammation with Lifestyle Changes
Exercise: Exercising muscles help to control after-meal blood sugar rises that damage tissues to cause inflammation. An extensive review of studies shows that exercise can reduce inflammation even more than statins do (Clin Chim Acta, Jun 3, 2010;411(0):785–793).

Weight Loss: Excess fat, particularly in your liver, causes inflammation, and having markers of inflammation can predict future weight gain (Diabetes, 2003 Aug; 52(8): 2097-2101). Apparently healthy people who have elevated blood markers of inflammation are at high risk for developing insulin resistance and diabetes (Circulation, Jul 4, 2000;102(1):42-7) and gaining fat that, by itself, increases inflammation (J Clin Invest, 2005;115(5):1111–1119). I recommend intermittent fasting for weight loss and weight control.

Avoid Toxins: Toxic substances damage cells to cause inflammation, so you should avoid or limit as much as possible your exposure to smoke, alcohol, recreational drugs or unnecessary prescription drugs, industrial chemicals, pollutants and so forth.

Treat Chronic Infections: Having any chronic infection turns on your immune system to cause inflammation (J Clin Invest, May 2, 2005;115(5):1111–1119), so identifying and treating chronic infections should be part of an anti-inflammatory lifestyle.

Anti-Inflammatory Diet: The food that you eat can turn on or turn off your immune system. See Anti-Inflammatory and Pro-Inflammatory Foods. All fruits, vegetables, nuts, whole grains, beans and other seeds contain soluble fiber that is converted to Short Chain Fatty Acids (SCFAs) in your colon. SCFAs dampen down inflammation, and lower high blood pressure and cholesterol.

Drugs to Reduce Inflammation and Clots
We have many studies that show that inflammation can cause clotting and heart attacks in people who have low and normal blood levels of cholesterol. Doctors regularly prescribe anti-clotting drugs to treat or prevent clotting, but statins are often the only drugs they prescribe that treat inflammation. Giving Canakinumab, a drug to block inflammation, to people with high, normal or low blood cholesterol levels has been shown to help prevent heart attacks even though it does not lower cholesterol (N Engl J Med, Sept 21, 2017;377:1119-1131). See Blocking Inflammation to Prevent Heart Attacks

While statins are routinely prescribed to lower cholesterol, reducing inflammation may be their most important function. The Jupiter study reported that giving statin drugs to people who had normal blood cholesterol levels and high levels of inflammation (C-reactive protein) resulted in 54 percent fewer heart attacks, 48 percent fewer strokes, 46 percent fewer angioplasties or bypass operations and 20 percent fewer deaths from any cause, compared with those taking placebos (NEJM, November 9, 2008).

My Recommendations
Inflammation can cause or contribute to heart attacks, strokes, some types of cancers, diabetes, obesity, auto-immune diseases, loss of muscle and bone, and many other diseases and conditions (J of the Am Heart Assoc, May 31, 2019). To a large degree, lifestyle changes can decrease inflammation, whether or not your doctor prescribes drugs. See Auto-Immune Diseases and Inflammation
Osteoarthritis Linked to Inflammation
Sarcopenia (Muscle Loss with Aging) Linked to Inflammation
Reduce Inflammation to Help Prevent Cancer

Checked 3/21/23