After telling patients for years that lowering their cholesterol levels is the only thing that matters in preventing heart disease, the average physician will now be forced to face the fact that maybe inflammation is more important than they have previously thought. The Nov. 20, 2008, issue of the New England Journal of Medicine published the results of the JUPITER trial. Consisting of almost 18,000 individuals with normal LDL cholesterol levels (less than 130 mg/dl) but high levels of C-reactive protein or CRP (greater than 2 mg/dl), this trial was done to determine if relatively weak anti-inflammatory properties of a statin drug would prove useful in cardiovascular prevention. Those who were getting a powerful statin drug had 50 percent fewer heart attacks and 20 percent less overall mortality than those getting the placebo. Does this mean that CRP causes heart disease or is it merely associated with it? For CRP to be an actual causal factor, it requires that genes associated with CRP should be increased in those patients that did get a heart attack and survived.
Another study published a week earlier in the New England Journal of Medicine indicated that was no increase in the genes associated with making CRP in patients with heart disease. So this means that there is no direct association with increased expression of CRP and heart attacks, and, therefore, measuring CRP only provides a marker of existing silent inflammation. However, it is known that the ratio of AA/EPA becomes elevated far earlier than any increase in CRP levels. The AA/EPA ratio is governed by the food we eat and in particular the levels of EPA in the diet.
This is why meta-analyses comparing all published statin trials and those trials using fish oil supplementation have shown that fish oil has a greater impact on decreasing cardiovascular mortality and all-cause than any statin drug. More importantly, the only reported side effect of fish oil is that it makes you smarter.