30-Year-Old Hidden Blood Test Finally Sees the Light?

Inflammation is originally a healing process to protect the body, but it can worsen into chronic inflammation when irritants are continuously introduced. Professor Lee Seung-hoon explained, "The damage to normal tissue that occurs during this continuous healing process becomes problematic over several years." He states that prolonged normal tissue damage is a core cause of disease.

Acute inflammation requires immediate suppression to prevent damage to surrounding organs. In contrast, chronic inflammation involves a continuous presence of irritants, so it is more fundamental to find the cause of the irritant rather than suppressing immunity. Professor Lee Seung-hoon emphasized, "Chronic inflammation is a situation where irritants are constantly entering, so there's no way to calm this zealous youth; in fact, it's more fundamental to see why these irritants keep appearing."

Immunity is divided into adaptive immunity, centered on antibodies, and innate immunity. Inflammatory responses mainly occur during innate immunity, where collateral damage happens as macrophages and neutrophils destroy invaders. Professor Lee Seung-hoon explained, "The collateral damage that occurs in the process. We call the pain and fever caused by pus inflammation," stating that this collateral damage is the cause of symptoms we perceive as inflammation.

Patients cannot feel the process of blood vessels narrowing in chronic inflammation, making it difficult to detect pain or signs as the disease progresses. Symptoms do not appear as long as organs function, and it proceeds virtually asymptomatically until acute thrombosis forms. Professor Lee Seung-hoon emphasized the danger of chronic inflammation, explaining, "We can't feel our blood vessels narrowing. But then suddenly, if they block completely that day, a cerebral infarction or myocardial infarction occurs."

C-reactive protein (CRP) is a representative indicator secreted rapidly by the liver during an inflammatory response. During infection, it surges from less than 0.2mg/L to over 10mg/L, acting as an opsonin to help immune cells. Professor Lee Seung-hoon explained, "Even with just a cold, it goes from below 0.2 to 10. So it jumps tremendously, and in medicine, these are called acute phase reactants — groups of protein peptides that surge in the body as a reaction when a major incident occurs." In chronic inflammation, it shows standardized changes, making it useful as a diagnostic marker.

In 1997, Professor Paul Ridker of Harvard Medical School first demonstrated the correlation between inflammation levels and cardiovascular disease through his Women's Health Study. His research revealed that higher CRP levels increased the risk of myocardial infarction and stroke by four times, and that taking aspirin reduced this risk. Professor Lee Seung-hoon emphasized the importance of the study, explaining, "Even after adjusting for all other factors, he proved for the first time in the world that if CRP is high, the rate of myocardial infarction and stroke increases by four times, and that if these people took aspirin, that risk would significantly decrease."

Clinical trials ensure objectivity by having an independent committee (DSNB), unrelated to the researchers, review the data. The DSNB can terminate a clinical trial early, referred to as a 'cold game,' if they determine the effect is too strong or nonexistent. Professor Lee Seung-hoon explained, "Phase III studies are essentially mandatory... if the interim analysis shows too big a difference, they tell you to stop," adding that this is done to protect patients and facilitate early treatment.

FDA approval means expanding the indication for an existing cholesterol-lowering drug, rosuvastatin (Crestor), so it can also be used for high-risk groups with elevated inflammation levels. This implies that insurance coverage for this drug can apply even to people with normal cholesterol levels. Professor Lee Seung-hoon explained, "Before, they would grant insurance coverage for lowering cholesterol. But this time, it's approved to also grant insurance coverage if you use it for people with normal cholesterol levels." The FDA advisory committee recommended approval with the condition of at least one risk factor.

The 2017 CANTOS study demonstrated that by controlling CRP levels, an inflammatory marker, with canakinumab, independent of cholesterol, cardiovascular events and mortality could be reduced by 20%. Professor Lee Seung-hoon emphasized, "This time, completely unrelatedly, by using an immunosuppressant that only acts on inflammation, it unexpectedly reduced myocardial infarction, stroke, and even mortality, so it's clear that inflammation is the problem." This study definitively proved that inflammation is an independent risk factor for cardiovascular disease.

After the JUPITER study was published, several researchers, including Michael de Lorgeril, publicly called the JUPITER study 'garbage' and published critical papers raising strong doubts about the study's reliability. Professor Lee Seung-hoon mentioned, "Several people, including Michael de Lorgeril, gathered and published papers saying the JUPITER study is garbage." They raised allegations of data manipulation and questioned the reasons for study termination, intensifying conflict within the medical community.

The American Heart Association's guidelines did not clearly state CRP levels, only mentioning them as one of several risk factors, showing an ambiguous stance. Professor Lee Seung-hoon pointed out, "The guidelines are very vague. They don't even record specific values above Paul Ridker's results, just mentioning CRP as one of several risk factors, with a footnote-like mention that CRP is included there." The evidentiary value of CRP was downgraded to Class 2, and there was no active supportive atmosphere from the association.

In 1983, Dr. Barry Marshall claimed that Helicobacter pylori caused gastric ulcers, but faced strong opposition from the medical community at the time. In response, in 1984, Dr. Marshall conducted an experiment by self-ingesting a Helicobacter pylori culture, directly proving the induction of gastric ulcers in his own body. Professor Lee Seung-hoon stated, "Feeling wronged, he drank a Helicobacter pylori culture the next year. He drank it and showed tissue samples from his own body." For this achievement, he was awarded the Nobel Prize in Physiology or Medicine in 2005.

The powerful anti-inflammatory effects of colchicine, previously used for gout, have been re-evaluated, opening up possibilities for its application in cardiovascular risk patients. Public interest investigator-initiated trials (IIT) by Australian and Dutch professors proved colchicine's efficacy in preventing cardiovascular disease, and the FDA swiftly accepted the pharmaceutical company's approval application due to the drug's low cost. Professor Lee Seung-hoon explained, "This one definitely has anti-inflammatory effects. Yes. But it's so certain that instead of using it with many side effects, let's significantly reduce the dosage and use it in low doses consistently for high-risk patients who might develop stroke or myocardial infarction," suggesting the potential for low-dose colchicine.

The advent of inexpensive drugs like colchicine has changed academic perspectives, and now the necessity of treating chronic inflammation in preventing cardiovascular disease is officially emerging. Professor Lee Seung-hoon stated, "Finally, in the prevention of cardiovascular disease and stroke, it's time for us to focus on and treat inflammation, chronic inflammation," emphasizing the importance of vascular inflammation level (hs-CRP) testing. This suggests a new phase has opened in cardiovascular disease treatment. Chronic inflammation management is expected to become a core pillar of future cardiovascular health.

Professor Lee Seung-hoon quoted Max Planck's famous saying about scientific progress, delivering a 'witty remark' that science progresses not by convincing its opponents, but by them disappearing and a new generation becoming accustomed to it. He said, "Science doesn't progress by convincing its opponents; it progresses when they die off and the next generation thinks, 'Oh, this must be true,' and gets used to it." This statement is interpreted as pointing out realistic issues within the medical community, such as factionalism and academic jealousy.

Professor Lee Seung-hoon recommended that people over 40 get regular hs-CRP tests. If the results are high, he advised retesting after 6 months to a year after lifestyle changes, and considering drug treatment if levels remain high. He emphasized, "Should those over 40 definitely get it? Try it once, then try changing your lifestyle, and if it's still high after 6 months or a year, you need to take medication." However, he pointed out the reality that there are currently no drugs approved for chronic inflammation as an indication in Korea, so treatment is done at the doctor's discretion.