1. Stents for Stable Angina

Stents are tiny mesh tubes that surgeons use to prop open arteries carrying blood to the heart. If a patient is having a heart attack, a stent can be a lifesaver. But for heart disease patients with stable angina — chest pain brought on by exertion or stress — a stent is not better at preventing a heart attack or prolonging survival than lifestyle changes such as exercising and taking statins to lower cholesterol, according to a landmark 2007 Department of Veterans Affairs study.

Despite stents' ineffectiveness, close to 500,000 are implanted each year for stable chest pain, says Sanjay Kaul, M.D., a cardiologist at Cedars-Sinai Heart Institute in Los Angeles. Surgeons frequently insert the stents during heart-catheterization procedures to evaluate patients' blood vessels, says Lee Lucas, Ph.D., an epidemiologist at Maine Medical Center Research Institute, who argues that the catheterization should be done first as a diagnostic test, and stenting done later, if necessary. "This should be a two-stage procedure, but patients never get to leave the cath lab to think about it," says Lucas.

Alternatives to Surgery
If your doctor orders a heart catheterization, ask that he or she wait to perform any treatment such as stenting in a separate procedure. Even before submitting to a heart cath, make sure you've explored other alternatives. Have you had a stress test? Do you adhere to a strict diet, exercise, or take medications to manage your cholesterol? "The reality is that 20 percent of patients who undergo this [catheterization with stents] do not have any symptoms, 30 to 50 percent have not had a stress test, and 30 percent are not treated with medical therapy first," says Kaul. If plaque is forming in your arteries, this is a systemic disease; a stent won't keep even a full inch of your arteries clear. You'll still need aggressive medical therapy to prevent future problems.

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