Common invasive procedures that open arteries to improve blood flow to the heart may not always be necessary for patients who have stable heart disease, according to a new federal study, which allows for more treatment options for those who have not had a heart attack.
Stents and coronary bypass surgery reduce chest pain caused by inadequate blood supply, but medication and lifestyle modifications are just as effective as these procedures in preventing heart attacks, heart-related hospitalizations and death in people who have blocked arteries.
The results give patients more options when it comes to deciding the best course of care with their doctor, says Elliott Antman, a Boston-based cardiologist at Brigham and Women's Hospital and a professor of medicine at Harvard Medical School. For example, surgery or stenting may be a better course for an active adult who experiences chest discomfort from coronary artery disease. Someone whose lifestyle is less affected by chest pain, however, may prefer a routine of medications that reduce cholesterol and blood pressure. Both paths of treatment equally reduce the risk of heart attack or death.
"Patients should understand that the benefit of the invasive approach is going to be relief of their discomfort,” says Antman, who was not involved in the study. Those who “truly adhere to optimal medical therapy,” maintain a healthy weight and avoid smoking “do quite well,” he adds.
For the study, which was presented this week at the annual meeting of the American Heart Association, researchers followed more than 5,000 adults with moderate to severe blockages for about three years. Some patients received drug therapy only; others were assigned to an intervention and drug therapy. The number of people who experienced a heart attack or died from heart disease was similar across the groups.
The results don't mean that stents and other interventions are bad or unnecessary, says Stuart F. Seides, a cardiologist and physician executive director at MedStar Heart & Vascular Institute in Washington, D.C. It's important to note that the study participants had stable, unchanging heart disease symptoms. “And if you look at many modern cardiac catheterization laboratories, patients with unstable coronary syndrome constitute the majority of patients who undergo coronary artery intervention,” he says.
The big takeaway from this study and others before it is that people with stable heart disease symptoms don't need to “rush to revascularization,” Seides says. They may be able to defer their decision safely and, along with their doctor, see how they do on medication.
"To me, this is fine-tuning. It helps you in terms of how you strategize with a particular individual patient,” Seides says.