A new way to fight heart disease may also tackle cancer

Researchers say they've proven a long-held theory about heart disease: that lowering inflammation may be nearly as important as cutting cholesterol levels.

They showed that using a targeted drug to reduce inflammation cut the risk of heart attacks, strokes and other "events" in patients who had already suffered one heart attack – independent of any other treatment they got.

A bonus side-effect – the treatment also appeared to have reduced rates of lung cancer diagnosis and death.

The studies, being presented at a meeting in Barcelona this weekend, are just a first step and do not yet open a door to a new way of treating heart patients.

And they don't necessarily apply to everybody. But Dr. Paul Ridker of Brigham and Women's Hospital and Harvard Medical School, who led the research team, thinks the findings will lead to ways to help people most at risk of dying of heart disease and stroke.

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World's healthiest vegetables
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World's healthiest vegetables

18. Romaine lettuce

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17. Artichokes

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16. Cauliflower

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15. Green pepper

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14. Tomato

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13. Corn on the cob

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12. Okra

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11. Carrot

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10. Green peas

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9. Cabbage (raw)

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8. Brussel sprouts

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7. Winter squash (baked)

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6. Broccoli

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5. Mixed vegetables

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4. Kale

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3. Spinach

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2. Potato, baked

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1. Sweet potato

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"This plays beautifully into the whole idea of personalized medicine and trying to get the right drug to the right patient," Ridker said.

Novartis, which makes the drug, said it would ask the Food and Drug Administration for permission to market the drug as a way to prevent heart attacks and would start further tests on its effect in lung cancer.

Ridker's team tested 10,000 patients who had suffered one heart attack already and thus were at very high risk of having a second one. The patients all had high levels of high sensitivity C-reactive protein or CRP, a measure of inflammation in the body.

They were already taking a basket of medications for their heart disease, from cholesterol-lowering statins to blood pressure drugs.

On top of that, the team added a drug called canakinumab, a monoclonal antibody or magic bullet agent that targets a specific cause of inflammation called interleukin 1 beta.

Volunteers got either a placebo, or injections every three months of low, medium or high doses of canakinumab.

After three to four years, people who got the highest dose of the drug were the least likely to have had another heart attack, stroke or to have died of heart disease.

Those who got the two highest doses of canakinumab had a 15 percent lower chance of having a heart attack, stroke or other major cardiovascular event, the team found. Patients were also less likely to need a heart bypass or angioplasty to clear out clogged arteries.

"For the first time, we've been able to definitively show that lowering inflammation independent of cholesterol reduces cardiovascular risk," Ridker said.

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The 12 best diets for heart health
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The 12 best diets for heart health

#12 The Fertility Diet

According to research from the Nurses' Health Study, on which The Fertility Diet is based, women who consume “good” fats, whole grains and plant protein improve their egg supply, while those who eat “bad” fats, refined carbohydrates and red meat may make fewer eggs and increase the risk for ovulatory infertility. Your heart may benefit from such an approach, too, suggests research finding that replacing animal protein with good carbohydrates might protect against heart attack, stroke or early death from cardiovascular disease and improve artery health and blood flow.

#8 (tie) Dr. Weil's Anti-Inflammatory Diet

The Anti-Inflammatory Diet, which is based on the heart-healthy principles of the Mediterranean diet, reflects creator Andrew Weil’s belief that certain foods cause or combat systemic inflammation. According to the American Heart Association, inflammation is not a proven cause of cardiovascular disease, but it is common among heart disease patients. Plus, the program emphasizes a steady supply of omega-3 fatty acids, which research suggests protect against heart disease.

#8 (tie) Flexitarian Diet

Flexitarian is a marriage of two words: flexible and vegetarian. The plan revolves around the idea that you don’t have to eliminate meat completely to reap the health benefits associated with vegetarianism; an occasional burger is OK. One large 2015 study of more than 450,000 Europeans found that those who ate a diet of at least 70 percent plant-based foods had a 20 percent lower risk of dying from cardiovascular disease than those who were least "pro-vegetarian." Earlier research suggests a semi-vegetarian diet also helps promote healthy blood pressure and cholesterol levels. As a bonus, it's good for the environment, one reviewer pointed out.

#8 (tie) Mayo Clinic Diet

Experts agree the Mayo Clinic Diet is a sound option for preventing or controlling heart problems. It focuses on coaching dieters to develop healthy, lasting habits around which foods they choose to eat and which to avoid. Plus, it reflects the medical community’s widely accepted definition of a heart-healthy diet: heavy on fruit, veggies and whole grains but light on saturated fat and salt.

#8 (tie) Vegetarian Diet

A vegetarian diet has the potential to decrease the risk of cardiovascular disease, according to experts, as long as vegetarians don’t load up on full-fat dairy and processed foods. As one expert reminds, "vegetarian diets can be healthy or unhealthy"; the beer-and-popcorn version is the latter. Still, if you take a well-informed approach, a vegetarian plan is a good bet for heart-conscious dieters, especially those who don’t have the heart to eat animals anyway.

#7 Engine 2 Diet

This low-fat, “plant strong” diet was created by Rip Esselstyn, a firefighter, former professional athlete and medical scion. It’s thought to prevent and often reverse diseases, like heart disease, caused by the so-called Standard American Diet and should also help keep cholesterol and blood pressure in check. If you adopt the Engine 2 Diet, you’ll load up on fruit, vegetables and whole grains and slash all animal products, processed foods and vegetable oils from your diet.

#6 Vegan Diet

Veganism earned high marks for its potential to boost cardiovascular health. It emphasizes the right foods – fruit, veggies and whole grains – while steering dieters away from meat, dairy and salty, processed choices. In a 12-year study that compared 6,000 vegetarians with 5,000 meat-eaters, for example, researchers found that the vegans in the group had a 57 percent lower risk of ischemic heart disease than the meat eaters. (The condition involves reduced heart pumping due to coronary artery disease and often leads to heart failure.) Just keep in mind that vegans may need to take supplements to make up for some heart-protective nutrients like the omega-3 fatty acids found in fish.

#5 MIND Diet

This plan is a mashup of two other expert-endorsed diets – DASH and Mediterranean – and zeroes in on the foods in each that specifically affect brain health (think green leafy vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil and wine). Turns out, the heart likes the same foods, studies show. A downfall of the MIND diet: Physical activity, proven important for heart health, is not addressed in the plan, some experts pointed out.

#4 Mediterranean Diet

What can’t this eating style do? The Mediterranean diet has been associated with a decreased risk for heart disease, and it’s also been shown to reduce blood pressure and “bad” LDL cholesterol. One 2015 study even showed that Italian vegans, vegetarians and others who followed a mostly Mediterranean diet had more short-chain fatty acids, which are linked to a lower risk of heart disease. Since the approach largely shuns saturated fat (which contributes to high cholesterol) and includes healthier mono- and polyunsaturated fats in moderation (which can reduce cholesterol), you’ll do your heart a favor by following it.

#3 TLC Diet

The Therapeutic Lifestyle Changes diet, created by the National Institutes of Health’s National Cholesterol Education Program, claims to lower “bad” LDL cholesterol by 8 to 10 percent in six weeks. Research concurs: In one Journal of Lipid Research study, participants who shifted from a typical American diet to the TLC Diet reduced their LDL cholesterol by 11 percent after 32 days. No matter your aim, the diet is "very healthy and safe for all individuals," one expert said.

#1 (tie) DASH Diet

The Dietary Approaches to Stop Hypertension program, or DASH, was created to help control high blood pressure – and it works. One expert called it "by far the best with data to back up lowering hypertension." Indeed, extensive research suggests it's one of your best bets if you want to lower your blood pressure as well as improve other markers of cardiovascular health. If you adopt the diet, you’ll emphasize the foods you’ve always been told to eat (fruits, veggies, whole grains, lean protein and low-fat dairy), while shunning those we’ve grown to love (calorie- and fat-laden sweets and red meat).

#1 (tie) The Ornish Diet

This rules-heavy plan has ranked No. 1 for heart health for seven consecutive years, although this year it shares the title with the DASH diet. Followers adhere to a strict regimen: Only 10 percent of calories can come from fat, very little of it saturated, and most foods with any cholesterol or refined carbohydrates, oils, excessive caffeine and nearly all animal products are banned. Research suggests the Ornish Diet, combined with stress-management techniques, exercise, social support and smoking cessation, could actually reverse heart disease.

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Dr. Steven Nissen, chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic, who was not involved in the study, said the results were impressive. "It shows us that people with high levels of inflammation - if you target the inflammation - you can reduce the risk of heart attack stroke and death," Nissen said.

The results are being presented at the European Society of Cardiology meeting in Barcelona, and also published in the New England Journal of Medicine and the Lancet medical journal.

It's been long known that both inflammation and cholesterol buildup are involved in heart and artery disease.

Inflammation is part of the body's immune process, and the patients in the trial were more likely to suffer serious infections, including pneumonia. The same thing happens to people taking immune-suppressing drugs to fight rheumatoid arthritis.

"Physicians would have to be cautious," Ridker said.

But the researchers found some other side-effects. People taking the higher doses of canakinumab had lower rates of cancer, especially lung cancer, as well as lower rates of arthritis and gout.

This makes sense to Ridker.

"If you smoke a pack of cigarettes, you chronically inflame the lung. If you are a long-haul truck driver breathing in diesel, you are chronically inflaming the lung," he said. Inflammation can drive cancer as well as heart disease, he said.

"These are fascinating, human findings that open a potential new class of therapies for cancer," said Dr. Laurie Glimcher, president and CEO of the Dana-Farber Cancer Institute.

Ridker does not believe the drug prevents cancer. He thinks inflammation may fuel the growth of some tumors.

"The tumors were obviously already there. They were just small and undiagnosed," he said.

The findings will not immediately mean new treatments for heart disease patients. For one thing, like any medical finding, they'll have to be replicated by other researchers. Ridker's testing another drug, methotrexate, that's also used to treat rheumatoid arthritis.

While canakinumab has already been approved by the FDA, it is a so-called orphan drug used to treat a very rare genetic condition. Sold under the brand name Ilaris, it costs about $200,000 a year.

"We look forward to submitting the ... data to regulatory authorities for approval in cardiovascular and initiating additional phase III studies in lung cancer," said Vas Narasimhan, who heads drug development for Novartis.

Ridker says he is pressing Novartis to try something different, perhaps offering the first dose of the drug free. People whose CRP levels fell more after their first dose also tended to be those who had lower rates of heart attacks and strokes years later.

"It might be worth taking one dose and see if you respond. If you don't, well, there is no reason to be on the drug," he said.

"This is the way to really focus these treatments on the patients on whom it really works. I think that's just good medicine."

In the end, Ridker believes, some extreme heart disease patients will be helped more by the newest cholesterol-lowering drugs, called PCSK9 inhibitors, while others may be better helped by targeted anti-inflammatory drugs.

"Half of heart attacks occur in people who do not have high cholesterol," he said. "For the first time, we've been able to definitively show that lowering inflammation independent of cholesterol reduces cardiovascular risk.

Nissen agrees.

"I think it's a game changer. The only good therapies we've had so far were statins. But now it seems like we have something new in the future," he said.

"It opens up pathways to new research and new treatments in the future. There are many other anti-inflammatory activities going on in our body, not just the one that's tackled by canakinumab. There will be so many more studies now to see if other therapies that tackle other pathways will also reduce the risk."

And the findings may offer some common-sense advice to everyone about lowering inflammation, Ridker said.

"There's a lot you can do about it right now," he said.

"If your high sensitivity C-reactive protein is elevated, you are a high-risk patient. This is overwhelming evidence that you should go to the gym, throw out the cigarettes, eat a healthier diet," he said.

"Because all three of those well-known interventions lower your inflammatory burden."

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