Bypass Surgery, Stents, and Angioplasty Increasingly Discredited

Bypass Surgery, Stents, and Angioplasty Increasingly Discredited

        In the New York Times on March 21, 2004, science writer Gina Kolata tells us why bypass surgery, angioplasty and stents do little to prevent heart attacks.

        Recent scientific studies show that heart attacks do not usually occur at the obvious areas of blockage seen on angiograms. Bypass surgery, angioplasty and stents do not benefit those areas of widespread arterial inflammation where most heart attacks originate.

Dr. Steven Nissen at the Cleveland Clinic has viewed many coronary arteries with a miniature ultrasound imager, threaded through the interior of the blood vessels. He found that coronary arteries were widely diseased with broad areas of superficial plaque that rarely blocked the flow of blood. His findings showed that the worst problem were not the obvious plaques causing blockages, but the other areas that were inflamed and threatening to rupture into the center of artery. Cardiologists and bypass surgeons did not want to hear that.

REFERENCES:

Schoenhagen P, White RD, Nissen SE, Tuzcu EM.Imaging of coronary atherosclerotic plaque. Z Kardiol. 2003 Jun;92(6):429-37.

Click on this link to read an abstract of the above cited article.

Nissen SE. Pathobiology, not angiography, should guide management in acute coronary syndrome/non-ST-segment elevation myocardial infarction: the non-interventionist's perspective. J Am Coll Cardiol. 2003 Feb 19;41(4 Suppl S):103S-112S.

Click on this link to read an abstract of the above cited article.

        Furthermore, experience now shows, with a few exceptions, that patients treated without bypass surgery or angioplasty do as well or better.

        REFERENCE:

Gemayel C, Waters D. Mechanical or metabolic treatment for coronary disease: synergistic, not antagonistic, approaches. Cardiol Rev. 2002 May-Jun;10(3):182-7.

Click on this link to read an abstract the report by Dr. Waters at the University of Connecticut Medical School.

Dr. Waters is quoted in the New York Times, “atherosclerosis is a systemic disease. It occurs throughout all the coronary arteries. If you fix one segment, a year later it will be another segment that pops and gives you a heart attack, so systemic therapy, with statins or antiplatelet drugs, has the potential to do a lot more." But, he added, "there is a tradition in cardiology that doesn't want to hear that."

"There is just this embedded belief that fixing an artery is a good thing," said Dr. Eric Topol, an interventional cardiologist at the Cleveland Clinic in Ohio.

As quoted from the New York Times, “Dr. Topol said, more and more people with no symptoms are now getting stents. According to an analysis by Merrill Lynch, based on sales figures, there will be more than a million stent operations this year, nearly double the number performed five years ago. “Some doctors still adhere to the old model. Others say that they know it no longer holds but that they sometimes end up opening blocked arteries anyway, even when patients have no symptoms.

“Dr. David Hillis, an interventional cardiologist at the University of Texas Southwestern Medical Center in Dallas, explained: "If you're an invasive cardiologist and Joe Smith, the local internist, is sending you patients, and if you tell them they don't need the procedure, pretty soon Joe Smith doesn't send patients anymore. Sometimes you can talk yourself into doing it even though in your heart of hearts you don't think it's right."

“Dr. Topol said a patient typically goes to a cardiologist with a vague complaint like indigestion or shortness of breath, or because a scan of the heart indicated calcium deposits — a sign of atherosclerosis, or buildup of plaque. The cardiologist puts the patient in the cardiac catheterization room, examining the arteries with an angiogram. Since most people who are middle-aged and older have atherosclerosis, the angiogram will more often than not show a narrowing. Inevitably, the patient gets a stent.

"It's this train where you can't get off at any station along the way," Dr. Topol said. "Once you get on the train, you're getting the stents. Once you get in the cath lab, it's pretty likely that something will get done."

“One reason for the enthusiastic opening of blocked arteries is that it feels like the right thing to do, Dr. Hillis said. "I think it is ingrained in the American psyche that the worth of medical care is directly related to how aggressive it is," he said. "Americans want a full-court press. . . Dr. Hillis said he tried to explain the evidence to patients, to little avail. "You end up reaching a level of frustration," he said. "I think they have talked to someone along the line who convinced them that this procedure will save their life. They are told if you don't have it done you are, quote, 'a walking time bomb.' "

    The New York Times article also quotes other experts: "The results are now snowballing," said Dr. Peter Libby of Harvard Medical School. "The disease is more mutable than we had thought...The changing picture of what works to prevent heart attacks, and why, emerged only after years of research that was initially met with disbelief.

“Early attempts to show that opening a narrowed artery saves lives or prevents heart attacks were unsuccessful. The only exception was bypass surgery, which was found to extend the lives of some patients with severe illness but not to prevent heart attacks [approximately 15% of patients were reported to have a 10% reduction in death rate by the 5th year after surgery]. It is unclear why those patients lived longer; some think the treatment prevented their heart rhythms from going awry, while others say that the detour created by a bypass might be giving blood an alternate route when a clot formed somewhere else in the artery.

“Some early studies indicated what was really happening, but were widely dismissed. As long ago as 1986, Dr. Greg Brown of the University of Washington at Seattle published a paper showing that heart attacks occurred in areas of coronary arteries where there was too little plaque to be stented or bypassed. Many cardiologists derided him.”
Blood levels of C-Relative Protein (CRP) measure the presence and severity of generalized vascular inflammation throughout the body. C-Reactive protein (CRP) is independently predictive for future heart attacks, strokes and other cardiovascular incidents. CRP levels are predictive across the full range, from very low levels to high levels, with no threshold effect. Click here for details.

    Medical treatment with blood pressure control, prudent lifestyle, and traditional prescription medications definitely decrease the risk of heart attack. Although statin drugs are also in this category, the severity and frequency of serious side effects using these medicines are commonly ignored. A program of intravenous EDTA chelation therapy benefits the entire length of every artery in the body simultaneously, and for that reason seems a wiser choice for most patients than the current unproven tip-of-the-iceberg fad using surgery or stents . Benefit from chelation therapy, combined with nutritional supplements, is also much safer than statin drugs.

Click here for Dr. Jay Cohen's warning about cholesterol lowering statin drugs

Click on the Links below to read what Duane Graveline, M.D., former NASA scientist and astronaut, writes about the potential dangers of cholesterol-lowering statin drugs.

Statin Amnesia, the True Cost

Benefit from Statins Unrelated to Cholesterol Lowering

Impaired Immunity, Increased Cancer Deaths with Statin Drugs

Obscure Symptoms and Mysterious can Occur as Side Effects from Statin Drugs

Heart Failure, Accelerated Aginf, Co-enzyme Q-10 and Statin Drugs

Statins and the Flyer

Statin Dialogues

Click on the Link below to read why vitamins, minerals and anti-oxidants may produce benefit by a similar mechanism to statin, cholesterol-lowering drugs but without the risk.

Vitamins, minerals and anti-oxidants also decrease heart attacks, without the risk

Nutrition Research Proves Major Benefit from Nutritional Supplements