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Patients uninformed about limitations of stent therapy

http://www.annals.org/content/153/5/307.abstract

Rethinking a longstanding practice - Prophylactic stenting of stenosis over 70% in stable patients

The patients selected for the study were patients with severe but stable heart disease. The common practice is to treat these patients with either heart bypass, angioplasty or stents. The study is designed to answer the question - Is there additional benefits of treating these patients with stents if they are already receiving optimal medical therapy?

 

 

The answer was - No. There were no additional benefits of using stents in stable patients.

 

 

Why was there no additional benefits? Stents do not prevent the rupture of unstable cholesterol plaques - the cause of most heart attack. Aggressive cholesterol does prevent plaque rupture.

Why optimal medical therapy is superior to stent therapy in stable patients

Another compelling reason for more aggressive preventive medical therapy and less aggressive stent therapy is this - only 14% of heart attacks involve an artery with more than 70% obstruction.

The vast majority - 68%, involve the rupture of a cholesterol plaque in an artery causing only mild and insignificant obstruction. Optimal cholesterol treatment benefits all the plaques in all arteries; stents does not. Cholesterol treatment prevents plaque rupture and the ensuing heart attack, stroke, coronary death, etc. that follow.

A stent treats only one severely obstructed segment of an artery. Optimal cholesterol therapy treats all the plaques (blue arrows) in the heart and also in the brain - stabilizing them and preventing rupture, the cause of most heart attacks and strokes.

Interventional lipidology is the type of cholesterol treatment than induces plaque regression.

In several IVUS (Intravascular Ultrasound) studies shown above, plaque regression was achieved when LDL-c was reduced by statin to less than 70 mg/dl.

Dr. Wolk's 2004 prediction is here - the treatment of CHD will continue to evolve from very aggressive intervention to the newer outcomes-based proactive prevention.

Cardiologists, cardiology fellows, policy makers, insurance companies and the public need to be more educated about prevention. Prevention is an option that is supported by a large volume of scientific data. Not only is it cost effective but, in the vast majority of cases, the better option.