If you have stable heart disease the initial treatment should usually be lifestyle changes plus drugs, not angioplasty, according to a study out today in the Archives of Internal Medicine. Yet, as we’ve previously reported, that’s not the way doctors treat most people with heart disease.
Angioplasty—an invasive procedure in which a doctor inflates a thin balloon in a narrowed artery to crush deposits, then leaves a cylindrical insert called a stent in place to prop the vessel open—clearly saves lives when performed as an emergency procedure in people who have just had a heart attack.
But in other people, the procedure isn’t lifesaving. Indeed, medical guidelines have for several years said that most people who have symptoms of heart problems, such as angina (chest pain on exertion), but have not had a heart attack, should be treated with lifestyle changes and drugs first. Yet less than half of patients in that situation are treated according to these guidelines before undergoing angioplasty, research suggests.
Some other recent studies had claimed to find benefits for angioplasty and stents compared to medication alone. But the authors of this latest analysis say those studies had problems, such as comparing outdated angioplasty techniques and drugs.
The new analysis, which combined the results of eight clinical trials, looked only at data that compared the most current angioplasty techniques and medications. It confirmed that people treated with drugs (including statins, ACE inhibitors, angiotensin receptor blockers, and aspirin) fared just as well as those who also underwent angioplasty with stents.
John Santa, M.D., director of the Consumer Reports Health Ratings Center, says
We've known for a while that drugs and lifestyle changes looked as effective and less risky than angioplasty as the initial therapy for most people with stable heart disease. Hopefully, this will put to rest any lingering doubts.
Angioplasty is also more expensive, the authors report. They said that by following current guidelines, 76 percent of patients with stable heart disease would save approximately $9,450 each in lifetime health-care costs. Other researchers have estimated such a shift would save $6 to $8 billion a year.
See our advice on how to treat heart disease, including the overuse of angioplasty. In addition, use our calculator to estimate your risk of having a heart attack in the next 10 years and see our Ratings of heart tests.
Initial Coronary Stent Implantation With Medical Therapy vs Medical Therapy Alone for Stable Coronary Artery Disease [Archives of Internal Medicine]