Most people diagnosed with heart disease try to find a cardiologist they can trust since they are placing their health in this person's hands. But perhaps that trust is not warranted. A new study shows that even the best heart surgeons are frequently doing their patients a disservice by performing stents that are of no benefit to those with stable heart conditions. In fact, according to the research, two-thirds of these procedures are undergone needlessly.
The study, which took place at Stony Brook University Medical Center in New York, focused on eight clinical trials that took place between 1997 and 2005.1 The researchers examined the treatment and results for 7,229 patients who had stable forms of heart disease such as stable angina, which presents as chest pain that appears upon exertion, or an asymptomatic narrowing of the arteries. Approximately half of these patients were treated with medication, and the other half were medicated as well as given stents.
The researchers then analyzed the follow-up health care of these patients for several years and found that those who had been treated with stents experienced no fewer occurrences of death, non-fatal heart attacks, chest pains, or emergency bypass procedures than their peers who had received only medication. They determined that surgery could be prevented in as many as three-quarters of those who have stable heart disease if medication was provided from the onset of the condition. (It's probably worth mentioning that the researchers seem to be unaware that previous studies have shown that perhaps even the medication itself isn't really needed…unless the patient has already had a heart attack.)
Stents are surgically inserted to hold blocked coronary arteries open. Angioplasty involves using a balloon to clear the blockage in an artery and keep it open. These are standard first line of defense therapies provided with or without medication to those with heart disease, but now it seems they may be causing many people to undergo procedures that are expensive, risky, and that are really not needed.
When going through all of the data and looking at the patients who only received medication, the researchers determined that two-thirds of them had no further symptoms and needed no further treatment. In only one-third of the cases were the medications insufficient to alleviate symptoms, making a stenting procedure necessary.
According to information from the American Heart Association, there are more than 400,000 stents placed in patients with stable heart disease annually.2 That's a heck of a lot of potentially unnecessary surgeries, and a lot of extra money spent in an already overburdened healthcare system. And yet another recent study found that more than half of these angioplasties and stentings in stable patients were performed before any medications were even tried.3
Jon Barron has written numerous times about all of the unproven practices that take place within the confines of conventional medicine, including the lack of proof that angioplasty benefits many patients. In fact, in a recent newsletter, he cites three different studies that all came to virtually the same conclusion: that using angioplasty to open blocked arteries and treat chest pain or angina may be riskier and no more beneficial than medication.4 So, you would think that with all this evidence piling up, the procedure would be eliminated or at least severely curtailed in use.
However, that's not the case at all. The reduction in angioplasty surgery since the evidence of its ineffectiveness was first published amounts to a mere 10 to 15 percent drop from its peak. Astoundingly, the medical community has responded not by decreasing the number of angioplasties, but by decreasing the amount of time required to get one once you're admitted to the hospital -- essentially rushing you into an unnecessary major procedure. That's certainly one way to respond to the data.
Ultimately, it comes down to always being your own advocate for all things medical. If you are given a diagnosis of stable heart disease -- or any diagnosis, for that matter -- it's really up to you to start doing your research. Don't just listen to the recommendation of your doctor, no matter how well regarded he or she is in the field. You need to read up on your condition and any suggested treatments before you consent to them because you don't want to end up in the hospital (which carries its own set of risks) unless it becomes absolutely necessary to your health.
1 Boyles, Salynn. "Stents Overused in Stable Heart Patients." WebMD. 27 February 2012. Accessed 4 March 2012. <http://www.webmd.com/heart-disease/news/20120227/stents-overused-stable-heart-patients>.
2 "What is a Stent?" American Heart Association. 21 June 2011. Accessed 4 March 2012. <http://www.heart.org/HEARTORG/Conditions/What-Is-a-Stent_UCM_309002_Article.jsp#.T1ZtwRzssg0>.
3 Sayburn, Anna. "Are heart patients having unnecessary surgery?" Consumer Reports. 17 May 2011. Accessed 4 March 2012. <http://news.consumerreports.org/health/2011/05/are-heart-patients-having-unnecessary-surgery.html>.
4 The BARI 2D Study Group. "A Randomized Trial of Therapies for Type 2 Diabetes and Coronary Artery Disease." N Engl J Med 2009; 360:2503-2515. http://www.nejm.org/doi/full/10.1056/NEJMoa0805796.