By: Jean Johnson for Heart1New international, multi-center research suggests that stable patients who underwent angioplasty plus stenting three to 28 days after a heart attack did no better than patients on drug therapy alone, says the National Heart, Lung, and Blood Institute (NHLBI).
Indeed, under increasing concern that angioplasty – a procedure that opens a blocked artery with a balloon so that a stent can be inserted to keep the blood vessel functioning – has been used to excess in unwarranted cases, the NHLBI helped fund a study to explore the issue.
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“We should not forget that controlling the risk factors for heart disease – such as high cholesterol and high blood pressure – can go a long way toward preventing heart attack in the first place,” said Alice Mascette, M.D., chief of the National Heart, Lung, and Blood Institute. To control cholesterol and high blood pressure:
Avoid fried foods and eat a moderate amount of healthy fats including various cooking oils and nuts.
Keep salt intake to two teaspoons daily, which is relatively easy to do if you are eating whole, fresh foods.
Stay active – shoot for thirty minutes per day. House work, yard work, and every step you take counts.
Mascette also recommends seeking help early when having heart problems: “There’s an important public health lesson to be learned from the OAT trial results: seek care very early after heart attack symptoms begin because that’s when there is a great deal of benefit from angioplasty.” |
“These results challenge the long standing belief that opening a blocked artery is always good,” said the NHLBI director, Elizabeth G. Nabel, M.D. “Instead, the study suggests that late angioplasty is unnecessary in this circumstance.” The chairman of the Occluded Artery Trial (OAT) joins Nabel in her assessment. “Our findings indicate that routine late opening of the heart attack related coronary artery is not appropriate and should be reserved only for certain patients such as those who are unstable or continue to have chest pain following a heart attack,” said Judith Hochman, M.D., study chair, the Harold Snyder Family professor of cardiology, clinical chief of cardiology, and director of the Cardiovascular Clinical Research Center in the New York University School of Medicine. Conclusions were unveiled at a recent meeting of the American Heart Association (AHA) in Chicago.
Results from the OAT research, which involved more than 2000 participants at 217 hospitals, will be published in a December 2006 issue of the New England Journal of Medicine.
According to the New York Times, “manufacturers sell $6 billion in stents a year, and cardiologists charge $10,000 to $15,000 each to implant them.” With as many as 50,000 patients poised to be affected by the new findings, these figures could shift. Our findings “should change practice, and I believe they will,” Hochman told the Times.
Similarly, in a news briefing at the Chicago meeting, Ray Gibbons, M.D., president of the AHA said, “Negative studies contribute to our understanding of what is really important. This is a good example of a negative study that will improve the efficiency of health care in this country. The U.S. health care system is remarkably inefficient.”
Between news of the study and on hearing Gibbon’s remarks, 45-year-old Sandra Douglas of San Francisco paused momentarily. “Once again, we are reminded that doctors and the health care industry are not infallible. I’m not so childish that I expect them to be, but on the other hand, my father has a heart condition.
“When I go to his appointments with him, I try to ask questions without giving the impression that I am second guessing the doctor – and believe me, if I come on too strong, my dad lets me hear about it later,” Douglas said with a laugh.
“You don’t want whoever you’ve entrusted the life of your loved one with to think you question their judgment. Besides, with angioplasty not being recommended across the board like it was, now I’m wondering what will help my father if he suffers a heart attack.”
At least Douglas doesn’t need to fear on this score. “The good news is there have been tremendous advances in drug therapy for heart attack patients,” said the NHLBI’s Nabel. “Drug therapy is an important treatment option.”
