Q&A with Cardiologist Richard Fleming

April 20 -- Dr. Richard M. Fleming, a nuclear cardiologist and founder of the Fleming Heart and Health Institute in Omaha, Neb., routinely uses a C-RP test, a simple blood test to scan patients' blood for signs of inflammation in coronary arteries that may lead to heart attacks. The test can raise the red flag early in heart disease — while you still have time to prevent serious damage.

Dr. Fleming spoke with ABCNEWS' medical editor Dr. Tim Johnson on 20/20 and answers viewers' questions below.

Denise Davis asks:I am a 48-year-old female with rheumatoid arthritis. I have been advised, due to the arthritis, that my CRP will be higher than normal.  My CRP has ranged from 5 to 17. My cholesterol rate is in the normal range. Should I be on a statin drug to reduce my chances of heart attack, or can diet alone produce the same results?

Dr. Richard Fleming:

There are many causes of inflammation that can lead to an elevated C-RP level. With "arthritis", you definitely have a reason for C-RP to be elevated. But it's important to remember that having "arthritis" doesn't make you immune to heart disease, nor does it mean you have heart disease. There are several other tests that we talk about that may be important to you. These include your triglyceride level, homocysteine, lipoprotein (a), fibrinogen, and interleukin-6 (see discussion in subsequent questions). Rather than discuss each of these here, suffice it to say that many of these respond to proper exercise and nutrition. I frequently recommend that people have these blood tests to see where they are starting at and then make the appropriate changes in diet and lifestyle. After several weeks I then suggest people have their abnormal tests (those which are high to begin with) repeated to determine how well they are doing. Many people report that their "arthritis" has improved after changing their diet and lifestyle and most doctors will be delighted that you are making these healthy lifestyle changes.

Judy Tindall asks:Hello,I just watched 20/20 where I was very interested about the blood test.  I learned so much from that segment that I didn't know.  I have had the test twice so far & my # was high.  Off hand I don't the exact # but my Dr. said she wants to watch keep a eye on it.  The only thing is she said she would do the test again later to see how I'm doing.  I didn't realize the danger was that high.  Even thought my cholesterol is normal she had me take the test because of my family history.  My mother died of a heart attack.  Also, my brother, who was only 47, died in his sleep.  I'm very interested in two things, what was that test called were it gave more information about the heart after you have the blood test.  Also, how can I find out information about the diet your guest is on.  I did just recently start the Ultimate Food Plan (by Dr. Phil) because I am overweight.

Also are there any trigger-foods to avoid?

Thank you for your time & take care, Judy

Dr. Richard Fleming:

The study showing improvement in the blood flow to her heart as well as evidence of reduced inflammation is a "myocardial perfusion imaging" (MPI) study. This is a special type of study used by Nuclear Cardiologists like myself to determine if your have coronary artery disease. We do these studies in a way that allows us to look for evidence of both heart damage and inflammation. The different diet regimens we use are presented in the book "Stop Inflammation Now!" and can be obtained through bookstores or the Internet. There are several weeks worth of recipes and menus in addition to explaining the role of inflammation in heart disease. These recipes and menus can not only help you improve you health but lose weight too.

Ajay Patel asks:What are the symptoms of heart inflammation. How can I get my CRP test done?

Dr. Richard Fleming:

Inflammation is the result of your bodies immunologic system recognizing something as wrong and trying to correct it. Our immunologic system has evolved over thousands of years and responds to everything going on in your body. When something occurs to damage your body, the cells of your immunological system (white blood cells, aka. Interleukins) come to your defense. The change includes redness, tenderness, pain and swelling. When this happens on your skin because you stepped on a nail, you can see this and feel it. But inside the walls of your arteries, this swelling isn't seen and there aren't nerves on the inner lining of your arteries to alert you to the pain. This means that this inflammation can go unnoticed inside the walls of the arteries of your heart, until this damaged "vulnerable inflammatory plaque" ruptures like a volcano into the inside of the artery where a blood clot forms, causing a heart attack. An excellent article was written by Mr. Mark Andersen and published in the Lincoln Journal Star (STAT Medicine-Health section) on January 13, 2004. The article is called "The Dynamic Duo". The CRP test can be done or ordered anywhere blood tests are done, including hospitals, clinics, and doctors offices.