Dear Dr. Mirkin,

Which blood test is a better predictor of heart attacks: CRP or cholesterol?

Both help to measure heart attack risk, but CRP (C-reactive protein) may be more important. CRP measures inflammation which indicates an overactive immunity, while cholesterol measures a type of fat in your blood. Having a high CRP blood test increases your risk of suffering a heart attack or stroke by twice as much as having a high cholesterol (NEJM, November 2002). Everything that activates your immunity can increase risk for heart attacks and everything that damages your body turns on your immunity. Inflammation is part of the immune reaction that protects you from infection. It causes redness, pain and swelling, and can damage the inner lining of arteries or break off clots from arteries to block the flow of blood which can cause strokes and heart attacks.

If you have a high CRP, try to correct the known causes: any type of infection such as chronic gum disease, high blood pressure, alcohol use, smoking, low levels of physical activity, chronic fatigue, eating a high protein/high meat diet, or having elevated triglycerides, insulin resistance or diabetes. People with sleep disturbances, depression, or any of the "auto-immune" diseases such as rheumatiod arthritis or psoriasis are also likely to have a high CRP and are at increased risk for heart attacks.

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