Heart Under Attack: The Hidden Role of Inflammation in Cardiovascular Disease

Understanding how heart inflammation contributes to atherosclerosis can help patients identify early signs of cardiovascular risk and make informed lifestyle choices.

According to the World Health Organization, cardiovascular diseases remain the leading cause of death globally, accounting for nearly 18 million deaths annually (World Health Organization, 2023).

Dr. Gradlin Roy, a dedicated cardiac surgeon known for his commitment to patient care, tragically passed away due to cardiac arrest, a stark reminder of how even the healthiest professionals are not immune to hidden heart risks.

Recent research highlights the vital role that inflammation plays in the pathogenesis of cardiovascular diseases acting silently to damage blood vessels and trigger plaque buildup.

Factors common in high-pressure careers like chronic stress, sleep deprivation, erratic eating patterns, and poor work-life balance can lead to a chronic inflammatory state which can slowly damage blood vessels over the years, increasing the risk of sudden cardiac events.

Dr. Roy's tragic death highlights the critical importance of managing lifestyle factors as they can silently fuel the inflammation cascade that threatens heart health even in seemingly healthy and informed individuals.

Atherosclerosis, the buildup of fatty plaques inside arteries, is driven by not just high cholesterol but also chronic inflammation. Factors such as high cholesterol, high blood pressure, smoking, and diabetes can damage the inner lining of arteries, triggering an immune response. White blood cells, acting as rescue rangers, rush to the site, engulfing the cholesterol particles, turning it into foam cells over time, forming the fatty streaks of early plaque. The site becomes like a wound that never heals, creating a feedback loop of a chronic state of inflammation.

An observational study of ASCVD adults undergoing C-reactive protein testing in Stockholm's healthcare system (2007–21) evaluated systemic inflammation over a 3-month period. This study highlighted that nearly 60% of adults with atherosclerotic cardiovascular disease (ASCVD) exhibit systemic inflammation, which is associated with higher rates of cardiovascular events and mortality.[1]

Medbound Times connected with Dr. Mehwish Shabeen, a Specialist Cardiologist based in Dubai, to discuss the role of inflammation in heart health.

Chronic inflammation in cardiovascular disease can be measured through specific biological markers that show how active the inflammation is. Markers like interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α) are associated with cardiovascular risk and disease progression.

According to the Health, Ageing, and Body Composition [Health ABC] Study, findings suggest an important role for IL-6 and TNF-alpha in clinical as well as subclinical cardiovascular disease. ^[2]

1. C-Reactive Protein (CRP): Produced by the liver in response to inflammation. Elevated CRP levels signal ongoing inflammation in the blood vessels and are strongly associated with heart attack and stroke risk.

2. Interleukin-6 (IL-6): Stimulates CRP production in the liver. It triggers plaque progression by promoting the recruitment of white blood cells to the vessel wall. Higher IL-6 levels have been linked to worse cardiovascular outcomes.

3. Tumor Necrosis Factor-alpha (TNF-α): A potent inflammatory cytokine that damages the endothelium and contributes to insulin resistance and metabolic disturbances that further worsen heart risk.

1. Unhealthy Diet: Excess consumption of processed foods, trans fats, seed oils, and refined sugars, coupled with low intake of healthy fats, greens, fruits, whole grains, and omega-3 fatty acids.

   An analysis of patients receiving secondary cardiac care found that a more pro-inflammatory diet was linked to a significantly higher likelihood of experiencing multiple cardiovascular events, including heart attack, stroke, and heart failure. This correlation was especially high among individuals consuming ultra-processed foods. ^[3]

2. Smoking & Alcohol: Tobacco smoke introduces toxins that directly injure blood vessels and trigger inflammation. Excess alcohol intake fuels inflammation by disrupting the liver and its functions.

3. Sleep Deprivation: Lack of proper sleep triggers inflammation by raising inflammatory proteins associated with a higher risk of high blood pressure, stroke, and heart attack. The National Sleep Foundation Poll conducted in the US found that many Americans have long-term sleep deprivation. It states that only one-third of the population reported sleeping 8 hours of sleep per night, and 31% reported sleeping 6 hours or less. Sleep deprivation is a common condition in modern society. ^[4]

4. High BMI & Metabolic Syndrome: Visceral fat is a major contributor of inflammatory molecules like TNF-alpha and IL-6, which are commonly associated with high blood sugar and heart diseases.

5. Chronic Stress: Stress causes increased cortisol and adrenaline levels in the blood that dysregulate the immune system, leading to persistent inflammation. Over time, this can damage the lining of your arteries, promoting plaque buildup and making it more likely to rupture.

6. Sedentary Lifestyle: Physical inactivity promotes weight gain and insulin resistance, along with high blood pressure and cholesterol, which contribute to a chronic inflammatory state in the body.

7. Uncontrolled Chronic Diseases: Diabetes, hypertension, and autoimmune conditions like lupus, rheumatoid arthritis, and HIV are associated with increased cardiovascular risk due to persistent inflammation. ^[5]

1. Best Anti-inflammatory Diet: Anti-inflammatory foods like green vegetables, fruits, oily fish, olive oil, and nuts help in inflammation treatment for heart health. Limiting intake of processed and refined food items can aid in preventing heart attack naturally.

2. Managing Stress and Regular Exercise: Workout, yoga, swimming, meditation, and relaxation exercises help reduce chronic inflammation and improve cardiovascular risk factors.

3. Sleep Quality: Sleeping for 7–9 hours daily helps the body to heal and plays a major role in reducing inflammation.

4. Quitting Smoking and Limiting Alcohol

5. Controlling Risk Factors: Managing diabetes, hypertension, obesity, and high cholesterol.

6. Medical Treatments to Lower Inflammation and Prevent Heart Disease:
   For many years, doctors have focused on lowering cholesterol, blood pressure, blood sugar, and associated inflammation with medications like statins, aspirin, and recently with colchicine. Clinical trials have demonstrated that colchicine reduces cardiovascular events by 31% among those with chronic coronary disease, and by 23% among those with recent myocardial infarction, making it an effective anti-inflammatory therapy in the prevention of acute coronary syndrome.^[6] However, caution is advised in patients with kidney or liver disease since the drug is cleared through these organs.

In some cases, drugs such as Canakinumab (an IL-1 blocker) have been tested to directly reduce inflammation after a heart attack. The Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS) showed a significant reduction of ASCVD (Atherosclerotic Cardiovascular Disease) events in patients with elevated baseline hs-CRP levels without affecting cholesterol by specifically targeting the inflammatory process. ^[7] These treatments are not widely available for everyday use because of cost and safety concerns.

Newer medicines are being tested, like Ziltivekimab and Pacibekitug, both of which block a substance called interleukin-6 (IL-6), a key messenger that fuels inflammation in the blood vessels. Larger studies are being conducted to see if these medicines can actually prevent heart attacks and strokes.

Chronic inflammation weakens the protective cover over arterial plaques, triggering their rupture and clot formation, blocking blood flow to vital organs, leading to heart attacks and stroke.

It not only causes blockages, but cytokines like TNF-α and IL-6 impair heart muscle contraction and promote tissue scarring (fibrosis), leading to stiffened heart muscle and failure.

A deeper understanding of the critical relationship between inflammation and cardiovascular disease is essential for advancing targeted therapies. Continued research into inflammatory pathways and biomarkers will help us to treat cardiovascular conditions effectively.

Human heart is precious: it doesn't need a miracle—it can heal itself miraculously by a few mindful habits and lifestyle changes, one step at a time.

Share this with someone who needs a reminder to care for their heart today!

References:

1. Mazhar, F., A. L. Faucon, E. L. Fu, et al. “Systemic Inflammation and Health Outcomes in Patients Receiving Treatment for Atherosclerotic Cardiovascular Disease.” European Heart Journal 45, no. 44 (2024): 4719–4730. https://pubmed.ncbi.nlm.nih.gov/39211962/.

2. Cesari, M., B. W. J. H. Penninx, A. B. Newman, S. B. Kritchevsky, B. J. Nicklas, K. Sutton-Tyrrell, R. P. Tracy, S. M. Rubin, T. B. Harris, and S. Pahor. “Inflammatory Markers and Cardiovascular Disease (The Health, Aging and Body Composition [Health ABC] Study).” The American Journal of Cardiology 92, no. 5 (2003): 522–528. https://pubmed.ncbi.nlm.nih.gov/12943870/.

3. da Silva, Alessandra, Matheus Brum Felício, Ana Paula Silva Caldas, Helen Hermana Miranda Hermsdorff, Ângela Cristine Bersch-Ferreira, Camila Ragne Torreglosa, Nitin Shivappa, James R. Hébert, Bernardete Weber, and Josefina Bressan. “Pro-inflammatory Diet Is Associated with a High Number of Cardiovascular Events and Ultra-Processed Foods Consumption in Patients in Secondary Care.” Nutrients 15, no. 4 (2023): 849. https://pmc.ncbi.nlm.nih.gov/articles/PMC10195276/.

4. Nagai, Michiaki, Satoshi Hoshide, and Kazuomi Kario. “Sleep Duration as a Risk Factor for Cardiovascular Disease: A Review of the Recent Literature.” Current Cardiology Reviews 6, no. 1 (2010): 54–61. https://pmc.ncbi.nlm.nih.gov/articles/PMC2845795/.

5. Rahman, Faisal, Seth S. Martin, Seamus P. Whelton, Freny V. Mody, Joban Vaishnav, and John William McEvoy. “Inflammation and Cardiovascular Disease Risk: A Case Study of HIV and Inflammatory Joint Disease.” The American Journal of Medicine 131, no. 4 (2018): 442.e1–442.e8. https://pubmed.ncbi.nlm.nih.gov/29269230/.

6. Banco, Darcy, Mohammad Mustehsan, and Binita Shah. “Update on the Role of Colchicine in Cardiovascular Disease.” Current Cardiology Reports 26, no. 4 (2024): 191–198. https://pubmed.ncbi.nlm.nih.gov/38340273/.

7. Martinez, Brandon K., and C. Michael White. “The Emerging Role of Inflammation in Cardiovascular Disease.” Annals of Pharmacotherapy 52, no. 8 (2018): 801–809. https://pubmed.ncbi.nlm.nih.gov/29557210/.

8. World Health Organization. “Cardiovascular Diseases (CVDs).” World Health Organization, 2023. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).

Reviewed by Dr. Sumbul, MBBS, MD Anatomy

Edited by M Subha Maheswari