This Inflammation Protein May Predict Heart Disease Better Than Cholesterol

This Inflammation Protein May Predict Heart Disease Better Than Cholesterol

Since the 1950s, doctors have linked diet, cholesterol, and heart disease. For decades, cholesterol levels measured through routine blood tests have been a key way to estimate a person’s risk of heart problems.

But research from the past 20 years tells a different story. A blood marker called C-reactive protein, which reflects low-level inflammation in the body, has emerged as a stronger predictor of heart disease risk than cholesterol alone.

Because of this growing evidence, the American College of Cardiology released new recommendations in September 2025. They now advise that all patients be screened for C-reactive protein in addition to having their cholesterol checked.

What is C-reactive protein?

C-reactive protein is made by the liver. It is released into the bloodstream when the body is dealing with infection, tissue injury, chronic inflammation from autoimmune conditions, or metabolic issues such as obesity and diabetes. In simple terms, it signals that the immune system is active.

This protein can be measured easily with a standard blood test. A C-reactive protein level below 1 milligram per deciliter suggests low inflammation, which is linked to a lower risk of heart disease.

Levels above 3 milligrams per deciliter indicate higher inflammation and a greater risk of heart disease. About 52 percent of Americans have elevated C-reactive protein levels.

Studies show that C-reactive protein predicts heart attacks and strokes more accurately than LDL cholesterol, often called “bad” cholesterol, and even better than lipoprotein(a), another inherited risk marker. One study found that C-reactive protein predicts heart disease just as well as blood pressure does.

Why does inflammation matter in heart disease?

Inflammation plays a role at every stage of atherosclerosis, the process where fatty plaque builds up inside arteries and can eventually cause heart attacks and strokes. When blood vessels are damaged by factors like smoking or high blood sugar, immune cells rush to the injured area. These cells absorb cholesterol particles circulating in the blood and form fatty plaques within the vessel wall.

This slow process can continue for decades. Eventually, immune-related activity can weaken and rupture the plaque’s protective cap. When that happens, a blood clot forms, blocking blood flow and cutting off oxygen to vital tissues, leading to a heart attack or stroke.

This means cholesterol is only part of the picture. The immune system drives the process that turns cholesterol buildup into life-threatening disease.

Can diet influence C-reactive protein levels?

Lifestyle choices have a major impact on how much C-reactive protein the liver produces. Research shows that certain foods can lower C-reactive protein levels. These include fiber-rich foods such as beans, vegetables, nuts, and seeds, along with berries, olive oil, green tea, chia seeds, and flaxseeds.

Weight loss and regular physical activity are also effective ways to reduce inflammation and lower C-reactive protein levels.

Does cholesterol still matter for heart disease risk?

Even though cholesterol may not be the strongest predictor of heart disease risk, it is still very important. What matters most is not just how much LDL cholesterol you have, but how it is packaged. Two people can have the same LDL cholesterol level but very different risks. That’s because risk is more closely tied to the number of cholesterol particles in the blood rather than the total amount of cholesterol.

More particles mean a higher chance that cholesterol will enter artery walls. A blood test called apolipoprotein B measures the number of these particles and predicts heart disease risk more accurately than standard cholesterol tests.

Like cholesterol and C-reactive protein, apolipoprotein B levels respond to lifestyle habits. Exercise, weight loss, and a healthy diet can reduce particle numbers. Diets rich in fiber, nuts, and omega-3 fatty acids are linked to fewer particles, while high sugar intake is associated with more.

Another important marker is lipoprotein(a), a protein attached to cholesterol particles. It makes these particles more likely to stick to artery walls and become part of plaque. Lipoprotein(a) predicts heart disease risk better than cholesterol alone.

Unlike other markers, lipoprotein(a) levels are determined entirely by genetics. Lifestyle changes do not affect it, and it only needs to be measured once in a lifetime.

What’s the best way to prevent heart disease?

Heart disease develops from a combination of many risk factors interacting over time. Because of this, prevention is far more complex than simply avoiding cholesterol in your diet. Understanding your LDL cholesterol along with C-reactive protein, apolipoprotein B, and lipoprotein(a) provides a more complete picture of your heart disease risk.

This knowledge can support long-term commitment to proven prevention strategies. These include eating a balanced diet, staying physically active, getting enough sleep, managing stress, maintaining a healthy weight, and quitting smoking if applicable.