March 21, 2004
Rethinking how best to prevent heart attacks
This NY Times article reports on new studies that increasingly indicate that coronary bypass opearations and angioplasty procedures are not as effective in preventing heart attacks in high risk patients than non-invasive treatments such as giving up smoking and taking drugs to control blood pressure, reduce cholesterol levels, and prevent blood clotting. The research reflects that that just one of those treatments -- lowering cholesterol to what guidelines suggest -- can reduce the risk of heart attack by a third. However, only 20% of heart patients follow that approach. As the Times article notes:
But, researchers say, most heart attacks do not occur because an artery is narrowed by plaque. Instead, they say, heart attacks occur when an area of plaque bursts, a clot forms over the area and blood flow is abruptly blocked. In 75 to 80 percent of cases, the plaque that erupts was not obstructing an artery and would not be stented or bypassed. The dangerous plaque is soft and fragile, produces no symptoms and would not be seen as an obstruction to blood flow.
That is why, heart experts say, so many heart attacks are unexpected ? a person will be out jogging one day, feeling fine, and struck with a heart attack the next. If a narrowed artery were the culprit, exercise would have caused severe chest pain.
Heart patients may have hundreds of vulnerable plaques, so preventing heart attacks means going after all their arteries, not one narrowed section, by attacking the disease itself. That is what happens when patients take drugs to aggressively lower their cholesterol levels, to get their blood pressure under control and to prevent blood clots.
Yet, researchers say, old notions persist.
"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.
Posted by Tom at March 21, 2004 7:42 AM |
This change in mindset about the pathogenesis of acute MI's has been slow to take hold within the medical profession - not unakin to the idea that bacteria (Helicobacter pylori) might cause gastric and/or duodenal ulcers.
It does, however, help explain the observed fact that while Cardiac Bypass surgery does reduce the frequency of angina-related chest pain, it does not change life expectancy significantly compared to medical management alone. In other words, you don't live any longer after Bypass, you live with less pain - or more realistically, a different type of pain, considering how much it hurts to have your chest cracked open like an oyster shell.....
Posted by: Jim Bob Baker at March 22, 2004 2:57 PM
Good points, Jim Bob. And to make matters worse, the health care system pays extraordinary amounts for expensive coronary bypass surgery while -- by virtue of third person payor nature of the health care system -- fails to provide the incentives for many people to follow the healthy habits that would reduce the risk of heart attacks. Maybe we can spur Dr. Lang to comment on this issue.
Posted by: Tom Kirkendall at March 22, 2004 6:03 PM
Several deaths record in my country in a cause of heat attack in recent year.
Posted by: Susan R at January 20, 2006 10:46 PM
you don't live any longer after Bypass, you live with less pain - or more realistically, a different type of pain, considering how much it hurts to have your chest cracked open like an oyster shell
Posted by: Amber at March 16, 2006 5:00 PM
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