Heart study casts further doubt on stents, bypass

[sman]

Heart study casts further doubt on stents, bypass

Stents and bypass surgery are no more effective than drugs for stable heart disease, highly anticipated trial results show

"https://www.washingtonpost.com/health/2019/11/16/embargoed-drugs-are-effective-invasive-procedures-patients-with-stable-heart-disease-major-trial-finds/"

Some of the most common invasive heart procedures in America are no better at preventing heart attacks and death in patients with stable heart disease than pills and lifestyle improvements alone, according to a massive federally funded study designed to resolve a long-standing controversy in cardiology.

Researchers found that invasive procedures to unclog blocked arteries — in most cases, the insertion of a stent, a tiny mesh tube that props open a blood vessel after artery-clearing angioplasty — were measurably better than pills at reducing patients’ chest pain during exercise. But the study, called ISCHEMIA, found no difference in a constellation of major heart-disease outcomes, including cardiac death, heart attacks, heart-related hospitalizations and resuscitation after cardiac arrest. There was no benefit to an invasive strategy in people without chest pain.

Overall, the keenly anticipated ISCHEMIA study results suggest that invasive procedures, stents and bypass surgery, should be used more sparingly in patients with stable heart disease and the decision to use them should be less rushed, experts said.

[nukecad]

That study is simply saying that cardiac stenting is no better at preventing Myocadrial Infarctions (Heart Attacks) than drugs.

Which is fair enough, cardiac stenting might seem a bit severe as a preventative measure, especially as you still have to take the meds following the stenting anyway.
TBH though it's not an arduous procedure, takes less time and is less painful than going to the dentist.

The study is not saying anything about cardiac stenting following a MI though.

I have multiple cardiac stents, the first one as an emergency measure following a MI and full Cardic Arrest 3 years ago. (Heart was stopped for 20 mins and had to be shocked back into action).
The others inserted about a month later as a routine out-patient appointment, back home the same day.
Again I wouldn't call it an invasive procedure, I was awake throughout both times, and watching the procedure on the monitor.
Yes I know that 'invasive' a medical term for anything surgical done inside the body, but have always felt invasive is too strong a term for many modern procedures.

[sman]

What i infer is that, when the root cause is something else symptomatic treatment like stent insertion is not the solution but to attack the root cause and take drugs accordingly, with life style changes. 

A cardiologist to decide course of treatment given the finding..

[sman]

And the fact that after MI further stenting gone for, ponts to problem in lifestyle, dietary issues which should be addressed to prevent further      cardio issues.. An immediate review of lifestyle and dietary aspects with your Cardipologist is must..Do take up with your cardiologist right away..

[sman]

Extreme Makeover: Life After a Heart Attack

"https://mendedhearts.org/story/extreme-makeover-life-after-a-heart-attack/"

Mike Anthony: From overweight and overworked to vegan marathoner
Mike Anthony, a member of Mended Hearts Chapter 140 in Bergen County, N.J., had a near-fatal heart attack in 2007, not long after his 40th birthday. While working stressful 14- to 16-hour days as a film location manager, Anthony gained 80 pounds and exercised only sporadically. After finishing a long stint managing the film What Happens in Vegas, Anthony got his wake-up call: a heart attack.

“My heart stopped when they were getting me ready for emergency stenting,” says Anthony. “It was a very shocking morning.”

Doctors implanted four stents total. “I thought my life was over,” he says. “The doctor said I had severe coronary artery disease. I didn’t want to accept that fate.”

Determined to slow the progression of his disease, Anthony entered cardiac rehabilitation and studied plans outlined by Drs. Dean Ornish, Caldwell Esselstyn and Joel Furman. “They all emphasize a plant-based diet — fruits and vegetables, high fiber, no meat or dairy, and little or no fat,” Anthony says.

He understood the benefits of veganism, but it took time for him to fully adapt to the diet and the lifestyle. “When I heard about athletes like Rich Roll and Scott Jurek, I realized you can be vegan and strong,” he says. “Then I could accept it.”

With two of America’s top ultra endurance athletes as inspiration, Anthony adopted a plant-based diet and started running. He lost all of those 80 pounds (give or take a few) and has completed four marathons and numerous half marathons. In April, he will run his first 50-kilometer race. “I’m not winning these races, but it feels so good to be healthy,” he says.

Anthony still works long days, but maintains a more reasonable schedule with less pressure. His cholesterol, formerly at 325, is down to normal levels. Junk food is a distant memory. “I don’t crave the old stuff,” he says. “I crave a big salad every day.”

For those who struggle to change their diet and start exercising, Anthony, always willing to help his Mended Hearts community, says to give it time. “As I began to feel better, it got easier,” he says. “I truly believe your body can heal itself if you eat well, engage in physical activity and rest.”

[nukecad]

It's three years since I had my Cardiac Arrest (I did say that above) and I'm doing fine.

I also find it interesting that you seem to have immediately assumed that the cause was due to lifestyle choices and being overweight. (Especially as you know nothing about my medical history or lifestyle).

You shouldn't just assume that all cardiac conditions are caused by lifestyle and/or diet, there are many genetic, congenital, and other causes.

[sman]

@nukecad i went by what you have stated, that there were 3 stent procedures and 2 after MI, which is why I felt your continued problems could be due to lifestyle, dietary related. But, if your doing fine.. It's good.. 

[sman]

Thousands of heart patients get stents that may do more harm than good

Stents are commonly used for stable chest pain — but the devices may not be helping.

"https://www.vox.com/science-and-health/2017/11/3/16599072/stent-chest-pain-treatment-angina-not-effective"

But studies show that stable angina can be well controlled with medication. And researchers have found that stenting chest pain patients doesn’t help them live longer or reduce their risk of disease — in fact, heart attacks and strokes can be potentially deadly side effects of stent procedures. There’s also been a lingering question about whether stents truly work to relieve pain.

[nukecad]

4 hours ago, sman said:

@nukecad i went by what you have stated, that there were 3 stent procedures and 2 after MI, which is why I felt your continued problems could be due to lifestyle, dietary related. But, if your doing fine.. It's good.. 

Sorry but you hadn''t read my post well at all,
My MI and full arrest happened in that order within two hours, one following the other.
I was actually in the ambulance going to hospital following the MI when I went into full arrest.
I was lucky in that respect, if I hadn't been in the ambulancewith the paramedic and equipment to hand then I'd probably be dead.
(I now call that date my Zombie Birthday, the day I died and came back to life).

I had 2 stenting procedures one as an emergency in the middle of the night, the second as soon as I'd recovered from the arrest and a regular daytime slot was available - one month later.
It wasn't 'continued problems' it was the same issue.

My particular cardiac problems (and eplipsy, and hypersomnolence/narcolepsy) stem from a neurological virus and encapathlitis that I had as a 3 yo infant, hardly a lifstyle or dietary issue.

As said that study is only about cardiac stents as a preventative measure, (in angina cases, etc.) and I agree that they are probably unnecessary for that.
However that is not the only reason for the use of cardiac stents - which is what I was pointing out.

TBH preventative stenting is not that common here in the UK, I guess it's more common un the USA which is where that study was done.
In the UK we do use meds and lifestyle changes as the preventative measures, with possibly angioplasty for more severe cases.

[sman]

@nukecad If you're doing fine, it's great.. (But would rather you may go thru' what you had mentioned, one following MI and others inserted a month later (ie. 2 more)). When following MI if one has to have 2 more stents, it only gives the impression that something is fundamentally out of place)..

Anyway, you're fine. that is what is needed. It's God's will..