This Silent Symptom Causes Half of All Heart Attacks—and It Has Nothing to Do With Cholesterol

Updated: Feb. 10, 2021

Half of all heart attacks happen in people with normal cholesterol. Now, a study may explain why and offer solutions for the other half of heart disease victims.

doctorChinnapong/ShutterstockTraditional heart-healthy advice often includes advice on keeping cholesterol in check. That’s because it’s well-established science that high LDL cholesterol—so called bad cholesterol—increases your risk of heart attack. Over the last decade or so, experts handing out advice on how to prevent heart disease have also addressed inflammation—though science had yet to conclusively prove that inflamed blood vessels and arteries directly cause heart disease. Until now, that is: In the annual meeting for the European Society of Cardiology, Paul Ridker, MD, presented direct evidence of inflammation’s role in heart troubles, finally explaining why half of all heart attacks happen in people with normal cholesterol.

In Dr. Ridker’s groundbreaking Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS), published in the New England Journal of Medicine, he and colleagues recruited 10,061 people who had a previous heart attack and who also showed elevated blood levels of a protein associated with inflammation—C-reactive protein, or CRP. The researchers administered three different doses of an anti-inflammatory drug called canakinumab (sold under the brand name, Ilaris). What they found is that the people who took 150 mg of canakinumab every three months (the middle of the three doses studied) had around 37 percent less inflammation and 15 percent fewer cardiovascular events (such as heart attacks), compared with the people in the placebo group.

Unfortunately, there’s a catch. Because canakinumab is an immunotherapy, it’s super expensive—about $200,000 per year. Currently, the drug is FDA-approved for treatment of two rare pediatric conditions: systemic juvenile idiopathic arthritis and cryopyrin-associated periodic syndromes. Because it’s “off-label” for heart disease prevention, insurance plans are unlikely to cover it for treating heart disease.

And here’s another catch: Like many immunotherapies, canakinumab comes with some rough side effects, including decreased immunity to potentially deadly infections. On the other hand, unlike some other immunotherapies, canakinumab, at the highest dosage studied, was shown in a separate study conducted by Dr. Ridker to reduce the occurrence of certain cancers. The 150 mg dosage was associated only with a slightly lower rate of lung cancer.

Since canakinumab is expensive and comes with significant health risk, the current takeaway from Dr. Ridker’s study may be more about tweaking our inflammation levels than about canakinumab, specifically. Adopting an anti-inflammation diet could be a great start, so make these 16 foods that reduce inflammation your nutritional staples. Getting regular exercise is equally important; just 20 minutes on the treadmill has anti-inflammatory effects. If you find regular activity a challenge, we’ve got the secret that’s going to make you love your workout.