Medication and lifestyle changes could be as effective as surgery for heart disease, trial finds

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The results of a large heart disease trial could be a game changer for patients with coronary artery disease. Researchers found when it comes to preventing heart attack or stroke, getting a stent or bypass surgery is no better than consistent use of medication and lifestyle changes.

The trial was led by researchers at NYU Grossman School of Medicine and Stanford University and was presented at the American Heart Association's Scientific Sessions conference over the weekend.

Researchers looked at over 5,000 patients with heart blockages who are stable. Putting in a stent was more likely to improve a patient's quality of life by cutting down on their symptoms like chest pain. But a stent didn't lower their risk of heart attack or stroke any more than taking medications or implementing lifestyle changes.

https://www.cbsnews.com/news/heart-disease-trial-finds-medication-and-lifestyle-changes-could-be-just-as-effective-as-surgery/

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1. Study Finds Limited Benefits of Stent Use for Millions With Heart Disease

PHILADELPHIA—Stents and coronary artery bypass surgery are no more effective than intensive drug treatment and better health habits in preventing millions of Americans from heart attacks and death, a large study found, shedding new light on a major controversy in cardiology. Researchers and doctors have fiercely debated for years how best to treat people who have narrowed coronary arteries but aren’t suffering acute symptoms.

The standard treatment has been to implant stents—wire mesh tubes that open up clogged arteries—or to perform bypass surgery, redirecting blood around a blockage. Those procedures are performed even though these patients either have no symptoms or feel chest pain only when they climb a few flights of stairs or exert themselves in some other way.

The study is the largest and among the most rigorous research yet to suggest that while stents and bypass surgery can be lifesaving for people who are having heart attacks, they aren’t necessarily better than cholesterol-lowering drugs and other changes in health habits for most people with chronic, or stable, coronary artery disease, which affects about 9.4 million Americans. But stents or bypass surgery work better than medicine and lifestyle changes alone in relieving symptoms for people who have frequent angina, or chest pain, the researchers found.

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At issue is how best to prevent heart attacks or other events. Cardiologists implant stents or perform a bypass to remove blockages in coronary arteries that reduce blood flow to the heart. Yet these large blockages, while frightening, don’t generally cause heart attacks, some research shows. They are caused instead more by ruptures in smaller, softer pieces of plaque that aren’t always visible on a scan. Medicines have improved over the past several years and shrink those dangerous small plaques, said Steven Nissen, chief academic officer of the Heart and Vascular Institute at the Cleveland Clinic. “The reason medical therapy is triumphing is that it’s treating the entire artery,” he said. “This is a systemic disease, not a local disease.” The results show “there is no compelling benefit to proceeding with these invasive procedures in people with stable symptoms as opposed to people with a heart attack,” he said.

More..

https://www.wsj.com/articles/study-finds-limited-benefits-of-stent-use-for-millions-with-heart-disease-11573931727 (paid subscription)

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2. More..

About three-quarters of the participants had a scan of their coronary arteries to make sure they had obstructive coronary disease. Those without narrowings in their arteries, or with a blockage in a main artery that supplies blood to a large portion of the heart were excluded, Dr. Hochman said. The participants then underwent a stent or bypass procedure along with intensive medical and lifestyle therapy, or were put on intensive medical and lifestyle therapy alone. That included cholesterol- and blood-pressure-lowering drugs, smoking cessation and changes in diet. Modern drug-eluting stents, which slowly release drugs to decrease the chances that blockages will recur, were used.

Researchers monitored participants for any of five events: a cardiovascular-related death, heart attack, resuscitation after cardiac arrest or hospitalization either for unstable chest pain or heart failure. There was no difference in the rate of those five disease-related events in both groups overall, Dr. Hochman said. The result was the same when comparing results for two serious events: heart attacks and a cardiovascular-related death, she said.

There were differences between the groups at certain points within those four years, the results showed. Six months into their treatment, the group with invasive procedures suffered a heart attack or other event at a higher rate—5.3%—than the group receiving medical therapy only, at 3.4%, suggesting complications from the procedures, Dr. Hochman said.

Half of patients who had invasive procedures for frequent chest pain were free of their symptoms a year after their treatment, compared with 20% who reported improvement after medical and lifestyle therapy alone, the researchers found, citing a likely benefit of modern, drug-eluting stents.

https://www.wsj.com/articles/study-finds-limited-benefits-of-stent-use-for-millions-with-heart-disease-11573931727 (paid subscription)

[Hoyt]

3. Bet a lot of cardiac surgeons and invasive cardiologists, are puckering.