Are Stents a Scam?
Angioplasty and stent placement are often recommended as a treatment for coronary artery disease, a leading cause of death. A study shows many of these procedures may be done unnecessarily.
STORY AT-A-GLANCE
Coronary angioplasty and stents are often recommended for treatment of arterial blockage in your heart muscle, the goal of which is to repair and unblock the artery
Researchers found this procedure may improve blood flow through the blocked artery but did not improve symptoms or exercise tolerance in study participants
While study participants didn't exhibit physical benefit, some expressed psychological relief when the blockage was repaired
Enhanced external counterpulsation is a noninvasive, effective treatment option to improve circulation to your heart muscle without the dangerous side effects associated with invasive heart procedures
Editor's Note: This article is a reprint. It was originally published November 22, 2017.
Angioplasty is a surgical procedure often recommended after an arterial blockage has been found in the heart muscle. Your heart requires a strong oxygen and nutrient supply, like other muscles in your body. There are two major coronary arteries that supply the left and right sides of your heart. By branching into smaller arteries they are able to supply the entire muscle with blood.
The goal of coronary artery angioplasty is to repair or unblock the blocked artery. During the procedure the surgeon inserts a thin expandable balloon that is inflated to flatten the blockage against the arterial wall.1 After the balloon is removed, the surgeon often places a stent with the intention of keeping the artery open and blood flowing freely.
There are currently five types of coronary artery stents available, each with different advantages and disadvantages to placement.2 However, while the different types of stents offer options for those for whom a stent is absolutely necessary, research shows those with stable coronary artery disease, stable angina, do not require stents.
Study Finds Stent Placement May Not Be Better Than Placebo
In a study published in The Lancet, researchers from Imperial College London investigated the difference between patients who had received a stent for stable angina and those who underwent a placebo intervention.3 In the short video above, lead author and interventional cardiologist Dr. Rasha Al-Lamee, describes the study and its results.
The researchers recruited 200 participants with severe single vessel blockage from five sites across the U.K.4 During the initial six weeks, all patients underwent an exercise test followed by intensive medical treatment. At that point they were randomly assigned to two groups.
The first underwent a percutaneous intervention (PCI) during which coronary angioplasty was performed and a stent was placed. The second group also underwent a PCI procedure with an angiogram but without a balloon angioplasty or stent placement.5
For the following six weeks, neither the patient nor the physician knew if the patient received the stent. At the conclusion of the six weeks, patients again underwent an exercise test and were questioned about their symptoms. The researchers found both groups experienced nearly identical improvements in exercise tolerance and no difference in reported improvements of their symptoms.6 From the data, Al-Lamee commented:7
"Surprisingly, even though the stents improved blood supply, they didn't provide more relief of symptoms compared to drug treatments, at least in this patient group. It seems that the link between opening a narrowing coronary artery and improving symptoms is not as simple as everyone had hoped."
The results were presented at the Transcatheter Cardiovascular Therapeutics symposium in Denver. Not surprisingly, the Society for Cardiovascular Angiography and Interventions (SCAI) questioned the conclusions, believing the surgical PCI is the preferred treatment.
The president of SCAI, Dr. Kirk Garratt, commented on the study, saying,8 "In 2017, we don't subject stable patients without symptoms to PCI, so this study doesn't properly reflect current PCI practice. Convenience and medication side effects are also big concerns for patients."
Featured Study Supports Previous Findings
Previous analysis of the benefits of stent procedures supports findings from the featured study. Patients in the U.S. spend $60 billion a year on invasive cardiovascular procedures.9 Although only 5% of the world's population lives on U.S. soil, Americans undergo half of the world's bypass surgeries and stent placements.
Of these stent placements, up to 50% may be done unnecessarily based on current medical guidelines,10 which is inconsistent with Garratt's assertion the procedure is done only when necessary.
In one study involving over 140,000 patients across more than 1,000 hospitals, researchers found nearly half of the stent procedures were unnecessary.11 Senior cardiologist in Apollo Health City, Hyderabad, India, Dr. Manoj Agarwal, commented on the overuse of stents, saying:12
"If you use a stent when the blockage is not significant or if it is in a non-critical artery, that is misuse and unethical. But there is no monitoring in India. The onus of monitoring ought to be on the institutions or hospitals where the procedures are done.
For many patients, undergoing an invasive procedure may put their minds at rest due to the ignorance surrounding the benefit of stents, when in fact a worryingly large majority are undergoing a procedure that will bring absolutely no benefit to their long-term prognosis."
In one study, researchers found 7.6% of those undergoing angioplasty experienced at least one serious side effect during hospitalization.13 More reports indicate serious complications may be experienced by up to 5% of individuals undergoing angioplasty.14 One of the largest hospital chains in the U.S., Hospital Corporation of America (HCA), came under scrutiny in 2012 when allegations were made that thousands of unnecessary heart procedures were performed.15
An investigation into HCA physicians revealed the doctors were unable to justify many of the procedures performed and in some cases made misleading statements in the medical records, making it appear the procedures were necessary to protect the life of the patient.16 Although HCA denied these decisions were financially motivated, cardiac procedures are among the more lucrative measures taken in hospital.17
Edward Hannan, Ph.D., from the University at Albany SUNY, was interested in how well physicians adhered to recommendations by the American Heart Association (AHA) and the American College of Cardiology (ACC). He and his colleagues gathered data from 58 hospitals in New York State and found a mere 36% met the criteria to undergo the procedure.18
Thus, while the featured study called into question the effectiveness of most angioplasty and stent insertions, many hospitals are also performing these procedures in unnecessarily large numbers.
Procedure Is Dangerous and Expensive for a Psychological Benefit
More than 1.5 million angioplasty and bypass surgeries are done each year in the U.S., making them the most commonly performed procedures.19 Although Americans are seven times more likely to undergo these surgeries than patients from Canada or Sweden, the death rate per capita is nearly identical in all three countries.
The AHA recommends angioplasty and potential stent placement if you are experiencing consistent chest discomfort or pain, or if the blockage puts you at immediate risk of heart attack or death. Dr. Catalin Toma, director of interventional cardiology at the UPMC Heart and Vascular Institute, commented on the results of the featured study, saying:
"Telling someone that they have a 90% blockage in an artery is an anxiety-inducing concept. And medications will treat the symptoms but not the blockage itself. A patient can have a hard time wrapping his or her mind around that. If the artery is blocked, they might think they need it to be unblocked."
He hopes the study will reduce the "knee-jerk reaction" physicians and patients have that any blockage should automatically require the placement of a stent. Dr. John Mandrola, cardiac electrophysiologist in Louisville, Kentucky, points out that he and many other physicians have watched patients report less chest pain, more energy and greater stamina after an angioplasty and stent.20
Mandrola elaborated that the thinking is that blockages are deadly and must be fixed. Thus, if a physician performs an angioplasty and shows the patient and family pictures of unblocked arteries, everyone is happy and the patient feels better. Mandrola continued:21 "This is a hugely disruptive study. The implications are huge. Billions of dollars have been spent, and many hundreds of thousands of patients have been exposed to the risks of PCI, without any documented benefit."
Dr. Rita Redberg, professor of medicine at the University of California San Francisco added:22 "I've been saying for many years that we don't know if patients feel better from stents, or if they feel better because patients always feel better when we do an invasive procedure. That's how the mind works."
Alternative Options May Have Greater Benefits
In this important interview, Dr. Thomas Cowan, family physician and a founding member of the Weston A. Price Foundation, discusses the function of your heart and circulatory system that may change the way you understand heart disease. He makes a strong case for heart disease being rooted in mitochondrial dysfunction and believes plaque formation is not nearly sufficient to explain a heart attack.
A noninvasive alternative treatment covered by Medicare and used in University settings23 is enhanced external counterpulsation (EECP). This is a painless treatment used to help develop collateral circulation in your heart muscle.
If you have blockage in your left anterior descending artery the procedure is not recommended. During the treatment, long inflatable cuffs are wrapped around your legs and buttocks. An electrocardiogram is used to time the inflation of the cuffs with the rhythm of your heart.
While your heart is at rest between beats, the cuffs inflate and squeeze blood from your legs toward your core. Physicians use this procedure to treat stable and unstable angina, chronic heart failure, coronary artery disease and ischemic cardiomyopathy.24
The additional pressure from the treatment triggers your body to form new blood vessels and thereby improve collateral circulation in your heart. This improved flow often eliminates angina pain and can improve your physical function up to 40%.
Each session lasts approximately an hour and you may need up to 35 sessions to achieve the desired results. The effects of the procedure typically last five to eight years. However, this noninvasive procedure is far preferable to the potential side effects from a PCI or the long-term side effects after placement of a stent. The treatment is very effective, not as costly as the invasive PCI, and is covered by insurance.
Cowan explains this procedure encourages the growth of new vessels in the way that high intensity strength training does. However, those with heart disease are physically unable to do this type of exercise to grow the strength of their heart. EECP does the work for them, so their exercise capacity improves and they can then do more of their own strength training.
Changing Your Daily Choices Reduces Your Risk for Angioplasty
Most chronic diseases are preventable by making simple lifestyle changes. Foundational principles to improve your metabolic health include nutritional choices, quality sleep, pure, fresh water and exercise. Generally speaking, focus your dietary choices on whole, unprocessed, organically raised, non-CAFO, non-GMO foods such as fresh vegetables, grass fed meats and raw dairy.
Seek out sustainable, healthy local sources and aim to eat the majority of your food raw. Fermented foods are also an excellent source of probiotics (and vitamin K2 if a special starter culture is used).
It is important to achieve optimal levels of vitamin D from sensible sun exposure. Vitamin D is essential for the health of your cardiovascular system and may help lower your blood pressure.25 Unfortunately, the vast majority of people in the U.S. are deficient.26 Blood levels between 60 and 80 ng/ml are ideal for preventing disease. It's important to use measured vitamin D levels to determine the amount of supplementation, if any, is needed.
Nearly as important as knowing what to eat, is knowing what not to eat. Topping the list is fructose and other forms of sugar that act as toxins when consumed in excess and drive multiple disease processes. You may find sugar added to processed foods and drinks under a number of different names. Sugar has become a staple in the Western diet and is likely a large contributor to the meteoric rise in numbers of people suffering from chronic illness.
While most nutritional experts blame the epidemic of chronic disease on the increase in sugar consumption, the role of sugar is relatively minor when compared to the impact of seed oils.
As for how much water you need, you may test your hydration by the color of your urine. Aim for a light straw color and urinating at least four times daily. Seek out pure, "living" water that imparts a significant number of health benefits. Your cells use negatively charged, structured "EZ" water to build and maintain your health.
Achieving quality sleep for eight hours each night is also important to supporting your mitochondrial health. During sleep your body produces melatonin that acts as an antioxidant for your mitochondria preventing oxidative stress from free radical damage. For more information on this relationship, see my previous article, "The Importance of Melatonin for Optimal Health."
A comprehensive exercise program will include stretching, strength training and high intensity interval training. The combination of these strategies reduces your risk for injury, improves your muscular health (including your heart) and improves your ability to do everyday living tasks.
Consider including a two- to three-minute exercise several times a day to release nitric oxide that will help relax your blood vessels and improve your blood pressure.
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