Inflammation now predicts heart disease more strongly than cholesterol

Summary

Inflammation now predicts heart disease more strongly than cholesterol Brandon Ballinger Sep 29, 2025 Chronic inflammation has long been known to double your risk of heart disease, but prior to now, inflammation has never been a SMuRF: standard modifiable risk factor for heart disease. The American College of Cardiology just released recommendations that change that. The ACC is now recommending that everyone measure inflammation (specifically, hs-CRP) via a blood test: Because clinicians will not treat what they do not measure, universal screening of hsCRP in both primary and secondary prevention patients, in combination with cholesterol, represents a major clinical opportunity and is therefore recommended. American College of Cardiology There were a many interesting bits of evidence that led to this recommendation. The whole article, published in JACC, is worth a read, but this blog post extracts a few of the most interesting parts — or at least, the parts I thought were most interesting. Want to skip ahead and measure your inflammation? Empirical Health's advanced heart health panel includes hs-CRP, ApoB, Lp(a), and other critical heart health biomarkers. For decades, LDL cholesterol (or ApoB) has been the main focus of cardiovascular risk assessment. But this chart shows hs-CRP is actually a stronger predictor of heart disease than LDL. Why? In some ways, cholesterol has become a victim of its own success. We now screen the whole population for high cholesterol, give statins to those with high LDL (or ApoB), and so then the majority of people who end up having heart attacks have lower cholesterol than they would naturally have. This means most of the majority of residual risk for heart attacks will be found in biomarkers that aren’t SMuRFs. Inflammation (hs-CRP) is one such non-SMuRF, one perhaps one of the strongest. This is especially true in people already on statins or those without traditional risk factors (sometimes called “SMuRF-less” patients). In these g...