Inflamed blood vessels key risk factor.

• Position: Cardiovascular Disease

For more than two decades, health professionals and medical researchers have pointed to cholesterol as a major culprit in the fight against coronary artery disease and heart attack. Public awareness has been raised, and today most Americans at least have had their cholesterol checked. Many people also know about HDL ("good") and LDL ("bad") cholesterol levels and the amount of fat in the foods they eat. Cholesterol, like blood pressure, is indeed a key to good heart health. Too much LDL cholesterol in the blood can accumulate in the arteries, forming plaque that can clog blood vessels (atherosclerosis) and cause heart attack, stroke, and other forms of vascular disease.

However, a growing body of research also cites blood vessel inflammation as a major independent risk factor for cardiovascular disease. University of Iowa, Iowa City, researchers report that very small amounts of endotoxin (a substance present in bacteria) cause a blood vessel reaction. Moreover, the findings suggest that drugs commonly prescribed to lower cholesterol also may reduce this inflammation, indicating an additional beneficial effect of the cholesterol-lowering drugs known as statins.

"Increased awareness about cholesterol and lipoproteins really took off in the 1980s and 1990s, which was, and still is, a good thing," says Neal Weintraub, associate professor of internal medicine and interim division director of cardiovascular diseases in the Roy J. and Lucille A. Carver College of Medicine, and a cardiovascular disease specialist at the university's Hospitals and Clinics. "But, over time, it became obvious that many patients with cardiovascular disease have normal lipid levels. In fact, a significant percentage of patients with atherosclerosis have none of the other known conventional risk factors, such as smoking, hypertension, and diabetes. Clearly, there are other aspects involved, and research in the pest few years has begun to identify inflammation as playing an important role."

Inflammation is a good thing in certain cases, such as signaling the body to send white blood cells to fight off infection and leading to the repair of cuts or wounds. Long term...