The Chinese New Year was celebrated on February 17 2026, marking the Year of the Fire Horse. This is a rare event as the last Fire Horse year was 1966. In honor of the Fire Horse, this month's column will discuss inflammation. The term inflammation comes from the Latin word "inflammare", meaning "to set on fire". Inflammation is the body’s defense system. The term conveys the idea that a fire is being lit to protect the body. When the body is faced with a stressor, such as an infection, a trauma, or a toxin, the inflammatory response is activated, isolating the insult, removing it and starting the healing process. The five symptoms of inflammation are: redness (rubor) in the area of injury, heat (calor), swelling (tumor), pain (dolor) and loss of function. Acute, short term (few days) inflammation is vital for protection and healing. However, chronic inflammation (lasting months to years) is harmful and attacks healthy tissue. How is the heart affected by inflammation? How can heart inflammation be detected and treated?
The heart is not immune to inflammation. Chronic inflammation leads to several types of heart disease. Coronary artery disease is felt to be an inflammatory process. If the wall of a heart artery is damaged (due to high blood pressure, diabetes or smoking) the immune system is activated and the inflammatory process is initiated to heal the arterial wall. Inflammatory cells and cholesterol come to the area to repair the damage. If the process continues over months to years (chronic inflammation) plaque is built up in the artery wall. If allowed to continue, this can lead to blockage in the blood flow to the heart muscle, causing chest pain. Alternatively, inflammation can cause acute rupture of a plaque leading to a heart attack. It is now well established that long-term, low-grade inflammation is the key to heart artery plaque formation, progression and rupture. In addition, congestive heart failure is driven by chronic inflammation. Inflammation promotes damage to the lining of the heart muscle (the endothelium) and scarring of the heart. This leads to destruction and weakening of the heart muscle. Inflammation is promoted by smoking, obesity, high cholesterol, elevated blood pressure, diabetes, and other chronic inflammatory conditions (such as periodontitis, chronic kidney disease, rheumatoid arthritis, COPD).
How can inflammation be detected and followed? The blood test C reactive protein (CRP) is a nonspecific marker of inflammation. CRP levels will rise due to multiple conditions such as an infection, a traumatic event, acute arthritis and chronic inflammation. The latter scenario makes it useful for detecting low level, chronic inflammation in heart disease. CRP levels less than 1 mg/L is low risk for chronic inflammation. CRP levels over 3 mg/L denote higher risk for cardiac inflammation. Levels over 10 mg/L usually are present with an active condition, such as an infection. It is felt that CRP is at least as strong a risk marker for heart disease as blood pressure and low-density lipoprotein (LDL).
How can chronic inflammation be treated? First and foremost are lifestyle changes to reduce the risk factors for chronic inflammation. This includes stopping smoking, losing weight and treating blood pressure, cholesterol and diabetes. Physical activity lowers CRP levels. Diet is vitally important as well. There are proinflammatory diets that increase the risk for inflammation and heart disease. On the other hand, the Mediterranean diet with olive oil, nuts and fatty fish intake lowers CRP and the risk for chronic heart disease. Proinflammatory foods include red meat, processed meat, refined carbohydrates and sweetened beverages. Anti-inflammatory items include green leafy vegetables, whole grains, fruits, tea, coffee. Many medications have been trialed to see if they reduce inflammation and cardiac risk. Statins lower both LDL and CRP and are the first line agents used to combat high cholesterol and chronic inflammation. Another cholesterol lowering agent, bempedoic acid, also reduces CRP by 20-30%. Colchicine has been used for many years as an anti-inflammatory agent in gout. Low dose colchicine has also been shown to reduce cardiac events in patients with known heart artery disease by 25%.
What else can be done to lower chronic inflammation? Aside from protecting against a nasty disease, and much like statins, the shingles vaccine has multiple secondary benefits. The shingles vaccine has been shown, in many studies across the world, to reduce the risk for dementia by about 20%. Now a new study showed that those with the vaccine had lower inflammation scores and that the vaccine actually slowed the aging process.
The Fire Horse symbolizes an intense, high-energy year dedicated to rapid change. So, make this the year you tackle your risk for chronic inflammation. Using the tools described here will keep you on track and in the horse race.
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