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Too Many Stents

In the last ten years, seven million North Americans have spent more than $110 billion to have stents put into the arteries leading to their hearts and many probably should not have had this surgical procedure in the first place. It is my opinion, and that of many heart specialists, that stents should not be put into the heart arteries unless a person has virtually complete blockage of blood flow to the heart, a sign of impending death of heart muscle, or uncontrollable chest pain. Stents can help people having a heart attack, chest pain, uncontrollable irregular heartbeats and perhaps those in heart failure. Stents have not been shown to prevent heart attacks or strokes.

The COURAGE Trial
The COURAGE research trial showed that patients with stable heart disease (no complete obstruction of blood flow to the heart) do just as well with medical treatment (drugs, exercise and a diet that includes lots of vegetables and fruit and restricts sugared drinks, sugar-added foods, red meat and fried foods) as they do with bypass surgery (N Engl J Med, 2007. 356(15):1503-16). This has been confirmed by other studies (Lancet, 2009, 373(9667): p. 911-8). Sudden chest pain or shortness of breath can be signs of complete obstruction of blood flow to the heart muscle.

The COURAGE trial showed that stents should not be used as first-line treatment to prevent heart attacks. Medication and lifestyle changes are as effective as stents in preventing heart attacks. Stents should be used to prevent heart muscle damage in an acute heart attack, and when heart pain, called angina, remains severe in spite of good medical treatment. A stent can help to relieve heart pain caused by blockage, but has not been proven to reduce the risk of a person suffering a heart attack in the future.

Cardiologists get paid less than $250 to talk to patients about lifestyle changes to prevent heart attacks, and the clotting risks of having a stent put into their arteries. Doctors receive an average $1,000 per stent. The range is $500 to $2,850, according to Medicare and Blue Book. Interventional cardiologists who put in stents earn a median income of $562,855 a year, as compared to $207,117 for family doctors, according to the Medical Group Management Association. Hospitals receive about $25,000 per stent hospitalization from private insurers, according to the Healthcare Blue Book website.

Dangers of Stents
Patients who receive stents are at increased risk for clots that cause heart attacks, bleeding from anti-clotting medicines and blockages from coronary scar tissue. People taking anti-clotting drugs will bleed excessively from a simple cut such as skin nicked while shaving.

Surgical Procedures Are Not Benign
Heart attacks are still the most common cause of death in western societies. Bypass surgery and stents have not been shown to prevent heart attacks and they also have not been shown to prolong life because they do not treat the cause of heart attacks (N Engl J Med, 2007;356:1503-1516). These surgical procedures are not benign. Many patients have died from perforated heart arteries and infections during and after the surgery. Others have had strokes and heart attacks caused by the clot-provoking effects of stents. Heart surgery is also incredibly expensive.

What Causes Heart Attacks?
The first event that sets you up for a heart attack is the formation of tiny holes in the inner lining of arteries. Then a clot forms and a plaque starts to form where the clot first appeared. As new holes appear in arteries, new plaques form in each hole until the inner linings of arteries are covered with plaques. A heart attack occurs when a piece of a plaque breaks off from the inner lining of the artery. A clot forms where the plaque broke off and the broken-off plaque travels down the ever-narrowing artery to completely block the flow of blood through that artery. A heart attack occurs when the part of the heart muscle supplied by that artery then gets no blood flow, lacks oxygen, hurts and eventually dies (Circulation, 2000;101:948-954).

How to Prevent Heart Attacks
Caldwell B. Esselstyn of the Cleveland Clinic reports that he has "halted and even reversed coronary artery disease" by changing what people eat (J Fam Pract, 2014 July;63(7):356-364,364a,364b). His team counselled 198 consecutive patients to convert from their usual diets to ones that are plant-based. Eighty-nine percent stayed on the diet and avoided dairy, fish, meat, and added oils for 3.7 years. This group had no heart attacks and only one stroke (0.6 percent). Of the 21 patients who did not stay on the diet, 13 suffered progression of their plaques, heart attacks and strokes (62 percent).

TMAO Forms Plaques in Arteries
TMAO (TriMethylAmine Oxide) is a chemical that punches holes in arteries and markedly increases the formation of arteriosclerotic plaques in these arteries (Nature Medicine, published online April 7, 2013 and N Engl J Med. 2013;368:1575-1584). Bacteria in the intestines make TMAO from carnitine, choline, lecithin, creatine and creatinine, found in red meat, eggs, milk and dairy products, liver, poultry, shellfish, fish, sports supplements and protein drinks. The diet used in Dr. Esselstyn's study avoided all of these foods and supplements. See Why Meat Eaters Have More Heart Attacks and More on TMAO.

The heart-attack-preventing diet used by Dr. Esselstyn is high in vegetables, whole grains, beans and fruit. It limits added oils, sugary foods and sugared drinks and other refined carbohydrates (which includes foods made from any type of flour). If this sounds familiar, it is basically the same diet I have been recommending for decades. Also try to exercise every day, avoid being overweight, and keep blood levels of hydroxy vitamin D above 75 nmol/L.

Checked 10/11/17
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July 13th, 2014
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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