The latest on stents

Here’s the latest on stents (those little wire cages inserted into blocked coronary arteries): if you’re having a heart attack, a stent (or bypass surgery) can be lifesaving. Otherwise, they have not proven to prolong life or prevent heart attacks. That is, if you’ve had procedures in a non-emergency situation that show some blockage in your arteries and/or if you have angina (chest pain), inserting stents into those arteries is not more beneficial than drugs at keeping you from heart attacks or death. (Stents do help with chest pain, but about a third of patients with stents develop chest pain again within 30 days to six months of the stent insertion and end up receiving another stent.) The drugs include statins—of which I disapprove—aspirin, blood pressure meds, and, in some cases, meds that slow heart rate (beta blockers).

This is not the first time that studies have come up with this result, but the newest study was longer and more thorough, putting earlier skepticism to rest . It followed 5,179 participants for three and a half years. All patients had moderate to severe blockages and most had a history of chest pain. They were randomly assigned to get only the “medical therapy” (drugs mentioned above); or “intervention” (stents or bypass surgery). Of those thousands of people, 145 people who’d had the intervention died compared with 144 who’d had only the meds. The number who had suffered heart attacks were also about evenly divided between the two groups.

These results, as with the results of earlier studies, are consistent with the current understanding of heart disease, namely, that narrowed arteries can usually be found throughout the arterial system, and docs can’t predict where in this system a problem might occur. Researchers no longer believe that “clogged pipes” cause heart attacks. Rather, heart attacks occur when a trigger, such as anger or physical exertion, causes damaged arteries to release blood clots that block the flow of blood to the heart. So just calm down and take it easy.

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