The role of inflammation and chronic disease is familiar. Inflammation is also a cause of aging. Let’s talk about the role of inflammation in cardiovascular disease and other degenerative diseases. The inflammatory response is part of our innate immunity. It occurs when tissues are injured by bacteria, viruses, trauma, toxins, heat and many other causes. In recent years, medical science has learned there are low levels of chronic inflammation, occurring at the cellular level. It is this kind of inflammation that is now linked to all of the degenerative diseases. In fact, it is thought by many authorities that low levels of chronic inflammation cause degenerative diseases. These diseases would include Alzheimer’s, type 2 diabetes, hypertension, cancer, stroke, heart disease, osteoporosis, accelerated aging, insulin resistance, altered immune function, rheumatoid arthritis and sarcopenia.
Sarcopenia is the loss of muscle tissue and strength associated with aging. It’s what causes frailty. Between the ages of 24 to 80, we can experience as much as a 40% loss in muscle size and strength—occurring at 1.4% per year and targeting mostly the fast-twitch muscle fibers, although slow-twitch muscle fibers are targeted as well. New research findings suggest inflammation may be an important cause of sarcopenia, which results in significant disability as we age. There are also higher rates of osteoporosis, insulin resistance, obesity, and arthritis among those with sarcopenia.
How do we detect inflammation? There are several markers that can be used for predicting inflammation, which would ultimately lead to cardiovascular events—including Interleukin-6, aerum amyloid A, tumor necrosis factor alpha, soluble intracellular adhesion molecules-1, macrophage inhibitory cytokine-1, sP-Selectin, CD40 Ligand and hs-C-reactive protein.
Definitions of Terms
Inflammation: local response to cellular injury is marked by capillary dilatation, leukocytic infiltration, redness, heat, pain, swelling and, often, loss of function. It serves as a mechanism initiating the elimination of noxious agents and of damaged tissue.
Cytokine: any of a class of immunoregulatory proteins such as interleukins, tumor necrosis factor, and interferon, secreted by cells, especially of the immune system.
Chemokine: any group of chemotactic cytokines, produced by various cells. Inflammation sites are thought to provide directional cues for white blood cell movement, such as T-cells, monocytes and neutrophils.
Endothelium: an epithelium of mesoblastic origin composed of a single layer of thin, flattened cells, which line internal body cavities and blood vessels.
Blood Cell Definitions
Leukocyte: white blood cells.
Monocyte: a large white blood cell with finely granulated chromatin disbursed throughout the nucleus. It is formed in the bone marrow, enters the blood and migrates into the connective tissue, where it differentiates into a macrophage.
Macrophage: a phagocytic tissue cell, derived from a monocyte; protect the body against infection and noxious substances.
Interleukin: any of various compounds with low molecular weight, produced by lymphocytes, macrophages and monocytes; regulates the immune system and cell-mediated immunity.
Cytokines: messengers of inflammation. A class of immunoregulatory proteins, such as interleukins, tumor necrosis factor and interferon, secreted by cells (especially immune system) that activate other nearby cells; promulgates the inflammatory cascade. Interleukin-6 is a powerful pro-inflammatory cytokine; it is the most important factor in controlling hepatic acute–phase response. Total body adiposity is the single most important determinant of serum interleukin-6 concentrations.
C-reactive protein is the ideal biomarker for inflammation. It is the one most clinically useful, especially in detecting cardiovascular inflammation. CRP screen now is recommended for patients at intermediate cardiovascular disease risk—a 10%-20% risk over the next 10 years. It is highly correlated with future risk of a cardiovascular event. The highly sensitive C-reactive protein must be measured with levels less than 1.0 desired. Levels between 1.0 and 3.0 are average risk; levels greater than 3.0mg/L are high risk. It is important for patients to know what their CRP levels are.
Patient factors associated with elevated CRP levels include . . .
- Body mass index greater than 25
- Metabolic syndrome
- Poor nutrition
- Sedentary lifestyle
- Dyslipidemia, which would include high triglycerides, low HDL and high LDL
- Chronic infection
- Cigarette smoking, both active and passive
- Excess alcohol intake
- Poor dental hygiene
- Rheumatoid arthritis
Patient factors decreasing CRP levels include . . .
Alcohol consumption in moderation: no more than one drink per day for a woman or two per day for a man. A drink is defined as 5 ounces of wine, 1½ ounces of liquor or one 12-ounce beer.
Exercise and physical activity
- Weight loss
- Medications, including statins, niacin and fibrates
- Omega-3 fatty acids
- Dietary fiber
- Right diet