YOUR HEART IN FLAMES

Inflammation may be the true cause of cardiovascular diseaseand there's a drug to treat it

- BY MELINDA WENNER MOYER

DOCTORS HAVE BEEN DRILLED FOR decades on the four big risks for heart disease, which kills more Americans every year than any other illness. The fearsome foursome: hypertension, smoking, high levels of "bad" LDL cholesterol and type 2 diabetes. Yet for just as long cardiologists have seen patients who have none of these problems die from heart ailments. And the heart specialists haven't had the slightest idea why.

Up to a quarter of the people admitted to hospitals for heart attacks don't have any of these four risk factors. Mysteriously, these "low-risk" heart disease patients actually have the worst outcomes. A 2023 analysis found that hospitalized acute coronary patients without any of the four hazards were 57 percent more likely to die compared with those who had at least one.

If the big known risk factors miss one in four patients, they still predict trouble as expected for the remaining three. That's a good record. But it also means that of the roughly 920,000 Americans who die of cardiovascular disease every year, about 230,000 of them will have done so for no understandable reason.

This deadly puzzle has haunted cardiologist Paul Ridker for years. "I remember saying to myself that there must be some other fundamental determinant of heart disease," says Ridker, who is director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital in Boston.