Pills as good as stents for stable heart patients: analysis
Bass said in an email that the study “misses the mark” on the quality-of-life concerns for patients and that stenting procedures helped relieve chest pain, or angina, in stable patients.
Dr. William Boden of the Samuel S. Stratton VA Medical Center in Albany, New York, who wrote a commentary in the journal, said relieving angina appeared to be the “last remaining sacred cow” for doctors who argue in favor of stents over drugs.
Boden is the lead author of a large study called COURAGE published in 2007 in the New England Journal of Medicine that was one of the first to challenge the value of stents and angioplasty over drug treatment.
Treatment for Blocked Arteries
Coronary artery disease or blocked arteries is a condition diagnosed with the help of a thorough physical examination, electrocardiogram, coronary angiography, a chest x-ray and prescribed blood tests. The blood tests are usually conducted to analyze and evaluate cholesterol level, diabetes and the thyroid hormone. The medical history of the family also plays a key role in determining the presence of this cardiac disorder in the individual. The treatment of blocked arteries involves, first and foremost, educating the patient on the life-threatening condition and explaining the outcome of the disease. Further damage can be prevented with the help of:
- Lifestyle changes like cessation of the smoking habit, a dedicated diet plan and very importantly, regular exercise.
- Medication prescribed by the doctor, which commonly includes beta-blockers, calcium-channel blockers and nitrates. Thrombolytic drugs are also prescribed to dissolve blood clots (if any), by increasing the blood plasmin level.
- Blood volume and pressure are lessened with the help of diuretics such as Esidrix and Diuril. Medication for blocked arteries also includes ACE inhibitors, angiotensin-2, vasodilators and statins.
- Surgical procedures such as coronary artery bypass and angioplasty or percutaneous transluminal coronary angioplasty, may be performed, in case the blockage is intense. In coronary artery bypass, the chest area is opened and a vein from the thigh or lower leg is used to enable the passage of blood around the blocked region.
- Coronary angioplasty is a procedure where a hollow tube or guide catheter is inserted into the artery. A catheter balloon is inflated within the artery to widen the walls. A stent is then placed in the artery to prevent it from narrowing again, thus restoring normal blood flow.
In that study, patients with chest pain did get slightly more pain relief with stenting, but those benefits only lasted one to three years. “They are not durable,” he said.
More recent studies could not show stents were any better than drugs at relieving angina, he contended.
Boden and Brown attribute the changes to improvements in medications, and given that most of them are generic, getting more doctors to choose drugs first could save a lot in health costs.
“In the context of controlling rising health care costs in the United States, this study suggests that up to 76 percent of patients with stable coronary artery disease could avoid percutaneous coronary intervention (such as stenting) altogether if treated with optimal medical therapy,” Brown and Stergiopoulous wrote.
But fewer than half of Americans with stable coronary artery disease who get a stent have been treated with drugs first, Dr. Rita Redberg, editor of the Archives of Internal Medicine, said in an editorial.