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Inflammation linked with cerebral small-vessel disease
A study published in the August 9 2005 issue of the journal Circulation (http://circ.ahajournals.org/) revealed yet another condition associated with inflammation. A team from the Erasmus Medical Center in Rotterdam, the Netherlands has found that an elevation of C-reactive protein (CRP, a marker of inflammation) is associated with an increased incidence of cerebral-small vessel disease, a condition characterized by white matter lesions and lacunar infarcts that is associated with an elevated risk of stroke and dementia.
The team evaluated findings from the Rotterdam Scan Study, which enrolled 1033 participants aged 69 to 90 from 1995 to 1996. The subjects underwent blood testing and an MRI scan of the brain upon enrollment, and the majority were reexamined after approximately three years.
It was found that individuals with higher levels of C-reactive protein showed a greater prevalence and progression of cerebral white matter lesions, particularly periventricular lesions. Subjects whose CRP level was in the highest 25 percent of participants experienced over 3 times the risk of marked periventricular white matter lesion progression than those whose CRP was in the lowest fourth.
In their commentary on the findings the authors suggest that CRP levels may be a marker for small-vessel disease in the same manner as for atherosclerosis, although CRP could be reflecting large-vessel atherosclerosis which is related to the condition and shares the same cardiovascular risk factors. Additionally the inflammation indicated by elevated CRP could be a response to ischemic tissue damage in the brain. Furthermore, this inflammation could be involved in the development of Alzheimer’s disease. The authors proposed that anti-inflammatory agents such as aspirin could slow the progression of these lesions and help prevent their related conditions.
Two types of thrombosis can cause a stroke: large vessel thrombosis and small vessel disease. Thrombotic stroke occurs most often in the large arteries, magnifying the impact and devastation of disease. Most large vessel thrombosis is caused by a combination of long-term atherosclerosis followed by rapid blood clot formation. Many thrombotic stroke patients have coronary artery disease, and heart attacks are a frequent cause of death in patients who have suffered this type of brain attack.
The second type of thrombotic stroke is small vessel disease which occurs when blood flow is blocked to a very small arterial vessel. Little is known about the specific causes of small vessel disease, but it is often closely linked to hypertension and is an indicator of atherosclerotic disease.
Chronic inflammation is associated with a variety of systemic diseases, including increased fibrinogen levels. C-reactive protein (CRP) is an early marker for systemic inflammation that rises before the erythrocyte sedimentation rate (ESR), the marker of inflammation used in conventional medicine. C-reactive protein appears to bind with LDL cholesterol, increasing its stickiness and vascular adherence. C-reactive protein is considered to be a highly sensitive risk factor for cardiovascular disease.
Several studies have examined the relationship between CRP levels and the risk of future strokes or myocardial infarction. One article related plasma CRP levels to incidence of first ischemic stroke or TIA in the Framingham Study original cohort. CRP levels were measured in the previously frozen plasma samples of 591 men and 871 women free of stroke/TIA during their 1980-1982 clinic examinations, when their mean age was 69.7 years. During 12-14 years of follow-up, 196 ischemic strokes and TIAs occurred. Independent of age, men in the highest CRP quartile had two times the risk of ischemic stroke/TIA, and women had almost 3 times the risk compared with those in the lowest quartile (Rost et al. 2001).
Several herbs that have multiple beneficial effects are anti-inflammatory. These include aspirin (derived from the bark of the white willow tree), turmeric (the yellow spice which contains curcumin), and the essential fatty acids found in fish, flax, perilla, and borage oils.
High dietary fiber intake is associated with lower levels of the cardiovascular risk factor C-reactive protein (CRP), according to data from the National Health and Nutrition Examination Survey (NHANES).
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