What role does inflammation play in heart disease?
Jonathan Sackner Bernstein, MD:
A tremendous amount of literature in the medical journals has focused on the role of inflammation in cardiovascular disease, specifically the risks of heart attacks.And I don't think there's any doubt that inflammation plays a role. However, what's less clear is whether treating inflammation itself is going to change someone's risk.And that may seem a little bit confusing, but it's almost the equivalent of taking circumstantial evidence in the court of law verses having three eye witnesses to the crime.To prove that something is going to a worthwhile intervention, a worthwhile treatment, you want to know a focused therapy,treating that inflammation in this case, reduces the risk of a heart attack or stroke independent of anything else that the person is being treated for.So if you look at statins, cholesterol lowering medicines, they can lower inflammation. Is that how they work? Well we don't know that thatis part of how they work, or it is not part of how they work, but in all of the studies that have been used to say that reducing inflammation is good,those have been with statins, that also improve cholesterol. So we don't really know how to treat inflammation.One of the drugs that is very powerful against certain components of inflammation is Vioxx. We know that Vioxx actually increases the risk of heart attacks and strokes.Now is that because of its effects on inflammation, or is it because it can cause blood clots? Probably because of blood clots,but I bring that example up to explain how difficult it can be to figure out whether a therapy is definitely good or not, and more relevant to the question,is whether a particular mechanism is relevant. There are a number of studies ongoing now.I think we'll be a lot smarter in the next 3 – 5 years about whether inflammation should be treated and whether there's be something that we can actually use.