Yes, the two are linked. Chronic, low-grade inflammation is part of how plaque forms in your artery walls, how it grows, and why it sometimes breaks open and causes a heart attack or stroke.
Inflammation does not replace cholesterol as a cause. Cholesterol-carrying particles start the process, and inflammation helps keep it going. That is why a careful look at heart risk often checks both.
Key takeaways
- Chronic low-grade inflammation helps plaque form, grow and sometimes break open.
- It works alongside cholesterol particles and does not replace them as a cause.
- This kind of inflammation causes no symptoms and shows up only on a blood test, usually hs-CRP.
- Trials in people with existing heart disease show lowering inflammation can reduce events, but that is no reason to take anti-inflammatory drugs on your own.
- Not smoking, regular activity, losing excess weight around the waist and enough sleep are tied to lower inflammation.
How inflammation helps build plaque
Plaque starts when cholesterol-carrying particles, the ones counted by an ApoB test, slip into the artery wall and get stuck there. Your immune system treats the trapped particles as a problem and sends white blood cells to clear them.
The cleanup never quite finishes. The white blood cells fill with fat, die, and leave debris behind. More immune cells arrive. Over many years this slow reaction turns a fatty streak into a plaque with a soft core and a cap of scar-like tissue over it.
Inflammation also affects how stable a plaque is. Plaques that tear open tend to have a thin cap with many immune cells in it. A tear can trigger a blood clot, and a clot is what blocks the artery in most heart attacks. Our guide to how arterial plaque builds up covers this step by step.
Short-term and chronic inflammation are not the same
Inflammation is not bad in itself. The swelling around a cut and the fever that comes with the flu are short-term inflammation doing its job. It settles when the job is done.
The kind linked to heart disease is different. It is mild, it causes no symptoms, and it can stay switched on for years. You cannot feel it. It shows up only on a blood test.
Does lowering inflammation lower heart risk?
For a long time this was only a theory. Three large trials have since tested it, all in people who already had heart disease.
The first, called CANTOS, enrolled 10,061 people who had survived a heart attack and still had a raised inflammation marker. They received either placebo or canakinumab, an antibody that blocks one inflammatory signal. At the dose that met the trial's main goal, heart attacks, strokes and cardiovascular deaths were about 15% lower than with placebo, with no change in cholesterol.1 The drug was also linked to more fatal infections, and deaths from any cause were no different.
Two later trials tested low-dose colchicine, an old anti-inflammatory medicine used for gout. In people with a recent heart attack, 5.5% of those taking it had a major cardiovascular event over about two years, compared with 7.1% of those taking placebo.2 In people with stable coronary disease, 6.8% of those taking it had a major cardiovascular event, compared with 9.6% of those taking placebo.3 In that second trial, deaths from non-cardiovascular causes were somewhat more frequent with colchicine, a difference that may have been chance.
These trials matter because they show that inflammation is a cause of heart events and not just a bystander. They do not mean you should take an anti-inflammatory drug to protect your heart. All three studied people with established heart disease, and the drugs carry real risks. None of them tested over-the-counter pain relievers. Any decision about medication belongs with your clinician.
Conditions that raise inflammatory heart risk
Some long-term conditions keep the immune system active for years. The 2018 US cholesterol guideline names chronic inflammatory disorders, such as rheumatoid arthritis, psoriasis and chronic HIV, as risk enhancers.4 A risk enhancer is something that pushes your real risk above what a standard calculator shows.
The effect can be meaningful. A pooled analysis of 14 studies found that people with rheumatoid arthritis had a 48% higher risk of a first cardiovascular event than the general population.5 Studies of psoriasis point the same way, especially when the skin disease is severe.
Everyday factors are tied to higher inflammation markers too:
- Extra body fat, especially around the waist
- Insulin resistance and type 2 diabetes
- Smoking
- Poor sleep and long-term stress
Having one of these does not make heart disease certain. It means your risk estimate deserves a closer look, and it is worth telling whoever assesses your heart.
How inflammation is measured
The usual blood test is high-sensitivity C-reactive protein, or hs-CRP. CRP is a protein your liver makes when inflammation is present. The high-sensitivity version picks up the low levels that matter for heart risk.
Under the 2018 guideline, an hs-CRP of 2.0 mg/L or higher counts as a risk enhancer when a treatment decision is uncertain. It is one piece of information to weigh, not a diagnosis.
The test has limits. hs-CRP is not specific to your arteries. A recent infection or injury can raise it for a while, so a single high reading is often rechecked.
There is also an honest caveat about the evidence. The US Preventive Services Task Force concluded in 2018 that the evidence was insufficient to judge the benefits and harms of adding hs-CRP to standard risk assessment in adults without symptoms.6 In plain terms, the test can sharpen the picture a little, but it has not been shown that testing by itself leads to fewer heart attacks.
What you can do about inflammation
There is no single fix. The habits that lower heart risk in general are the same ones tied to lower inflammation: not smoking, regular physical activity, losing excess weight around the waist, and sleeping enough.
If you live with an inflammatory condition, keeping it well controlled with the specialist who manages it matters for your heart as well as your joints or skin.
Your next step: find out where you stand
If inflammation is a question for you, start with our hs-CRP test guide. It explains the ranges, what throws the result off, and how the number is used alongside other tests.
You can also answer the three quick questions in the Cardio Res-Q screener on our program page to see whether a closer evaluation makes sense for you.
Are You a Candidate for Cardio Res-Q?
Three quick questions about the risk factors we screen for. Your answers stay between you and the clinic.
Frequently asked questions
Can I feel inflammation in my arteries?
No. The low-grade inflammation linked to heart disease causes no pain, swelling or fever. It is found with a blood test, most often hs-CRP, and even then the result reflects inflammation anywhere in the body and not only in the arteries.
Does a high hs-CRP mean I have heart disease?
No. hs-CRP rises for many reasons, including a recent infection or injury. A persistently raised level is one sign that your risk may be higher than your other numbers suggest, and it is weighed together with your cholesterol particles, blood pressure, blood sugar and family history.
Should I take an anti-inflammatory medicine to protect my heart?
Not on your own. The trials that showed a benefit were done in people who already had heart disease, used specific prescription treatments, and found real side effects. Whether any medicine is right for you is a decision to make with your clinician.
I have rheumatoid arthritis or psoriasis. What should I do?
Tell the clinician who assesses your heart risk, because guidelines treat these conditions as risk enhancers. A standard calculator may underestimate your risk, so it is reasonable to ask whether extra testing would change your plan.
Related reading
This article is for general education and is not medical advice. Decisions about testing and medication should be made with your clinician. If you have chest pain or other symptoms of a heart attack, call 911.
