Do Angioplasty Heart Stent Procedures Work?

Do Angioplasty Heart Stent Procedures Work?
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There are demonstrably no benefits to the hundreds of thousands of angioplasty and stent procedures performed outside of an emergency setting. They don’t prevent heart attacks, enable you to live longer, or even help with symptoms any more than placebo (fake) surgery.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

The large national cardiology conferences may attract the majority of cardiologists in the entire country to one place. So, hey, if you’re going to have a heart attack, that would seem to be the place to do it. And indeed, that’s when the American Heart Association president had his, within hours of his presidential address. With so many of the nation’s top cardiologists at the conference, maybe that’s a bad time to go into cardiac arrest anywhere else, though. You don’t know, until you put it to the test.

To their surprise, they found substantially lower mortality among those going into cardiac failure or cardiac arrest during the big national cardiology meetings. Why is the death rate lower when most of the cardiologists are away? One potential explanation is that the intensity of care may be lower, suggesting the harms of such care may unexpectedly outweigh the benefits. Their results echo paradoxical findings documented during a labor strike by Israeli physicians, during which mortality rates evidently dramatically fell. And it wasn’t just one strike. This has been looked at multiple times, and in all reported cases, mortality either stayed the same or decreased. In four of the seven cases, mortality dropped as a result of the strike, and in three, there was no significant change.

The fact is that many current medical practices have been found to offer no benefit, and, in fact, potential harms. Even physicians themselves estimate that about one-fifth of medical care is unnecessary. A national summit was convened by the joint commission that accredits hospitals and the American Medical Association to identify areas of overuse—treatments that provide zero or negligible benefit—potentially exposing patients to the risk of harm for nothing. They called out five practices: for example, prescribing antibiotics for viral upper respiratory tract infections, spending a billion dollars prescribing drugs that don’t work (and if anything just make things worse). But another overused practice they identified was elective percutaneous coronary intervention––in other words, angioplasty and stents.

Just to get everyone on the same page before we dive in, coronary artery disease, the #1 killer of men and women, involves blockages in the blood vessels that supply the heart muscle itself. Low blood flow can lead to a type of chest pain called angina or, if severe enough, to a heart attack. Plant-based diets and lifestyle programs have been shown to reverse these blockages by treating the cause of why our arteries are clogging up in the first place. But, for those unable or unwilling to change their diets, there are drugs that can help, as well as more invasive treatments such as open-heart surgery to try to bypass the blockage, or percutaneous coronary intervention. That’s when doctors insert small balloons or metal tunnels, called stents, up through the large blood vessels typically in the groin, and thread them all the way up into the heart. That way, you can then get inside the blocked vessels, and try to open them up and prop them open. During a heart attack this can be lifesaving. But hundreds of thousands of these procedures are done every year for stable angina, meaning on a non-emergency basis, which can relieve symptoms but doesn’t actually reduce your risk of having or dying from a heart attack in the future.

However, not everyone knows that. They mistakenly think the procedure offers more than just symptom relief. That’s one of the reasons I’m doing this video series. As Harvard put it, stents are for pain, not protection. But then, unbelievably, it was discovered that stents may not even help with pain, as revealed in this double-blind, randomized controlled trial. Wait, you can blind people to the active treatment in drug trials by giving them a placebo sugar pill, but wouldn’t you kinda notice if you got surgery or not, whether or not they cut into your groin? Not if you got sham surgery—placebo surgery—where they cut into everyone, thread up the catheter, and at the last moment, randomly actually do or do not actually place the actual stent. And those who got the fake surgery did just as well as those who got the regular surgery. Wait, there are no benefits to angioplasty and stents outside of an emergency setting? Doesn’t prevent heart attacks, doesn’t enable you to live longer, and doesn’t even help with symptoms? And since the procedure carries risks—including death—maybe stents should be used only for people who are actively having heart attacks. But wait, so hundreds of thousands of people are getting these operations for nothing? How do the doctors justify it? Is it just greed? How do they get patients to sign up it? Do they just not tell them the truth? And wait, why doesn’t it work? After all, you are opening up a blocked artery. There are just so many questions, which we’ll start addressing next.

Please consider volunteering to help out on the site.

Video production by Glass Entertainment

Motion graphics by Avocado Video

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

The large national cardiology conferences may attract the majority of cardiologists in the entire country to one place. So, hey, if you’re going to have a heart attack, that would seem to be the place to do it. And indeed, that’s when the American Heart Association president had his, within hours of his presidential address. With so many of the nation’s top cardiologists at the conference, maybe that’s a bad time to go into cardiac arrest anywhere else, though. You don’t know, until you put it to the test.

To their surprise, they found substantially lower mortality among those going into cardiac failure or cardiac arrest during the big national cardiology meetings. Why is the death rate lower when most of the cardiologists are away? One potential explanation is that the intensity of care may be lower, suggesting the harms of such care may unexpectedly outweigh the benefits. Their results echo paradoxical findings documented during a labor strike by Israeli physicians, during which mortality rates evidently dramatically fell. And it wasn’t just one strike. This has been looked at multiple times, and in all reported cases, mortality either stayed the same or decreased. In four of the seven cases, mortality dropped as a result of the strike, and in three, there was no significant change.

The fact is that many current medical practices have been found to offer no benefit, and, in fact, potential harms. Even physicians themselves estimate that about one-fifth of medical care is unnecessary. A national summit was convened by the joint commission that accredits hospitals and the American Medical Association to identify areas of overuse—treatments that provide zero or negligible benefit—potentially exposing patients to the risk of harm for nothing. They called out five practices: for example, prescribing antibiotics for viral upper respiratory tract infections, spending a billion dollars prescribing drugs that don’t work (and if anything just make things worse). But another overused practice they identified was elective percutaneous coronary intervention––in other words, angioplasty and stents.

Just to get everyone on the same page before we dive in, coronary artery disease, the #1 killer of men and women, involves blockages in the blood vessels that supply the heart muscle itself. Low blood flow can lead to a type of chest pain called angina or, if severe enough, to a heart attack. Plant-based diets and lifestyle programs have been shown to reverse these blockages by treating the cause of why our arteries are clogging up in the first place. But, for those unable or unwilling to change their diets, there are drugs that can help, as well as more invasive treatments such as open-heart surgery to try to bypass the blockage, or percutaneous coronary intervention. That’s when doctors insert small balloons or metal tunnels, called stents, up through the large blood vessels typically in the groin, and thread them all the way up into the heart. That way, you can then get inside the blocked vessels, and try to open them up and prop them open. During a heart attack this can be lifesaving. But hundreds of thousands of these procedures are done every year for stable angina, meaning on a non-emergency basis, which can relieve symptoms but doesn’t actually reduce your risk of having or dying from a heart attack in the future.

However, not everyone knows that. They mistakenly think the procedure offers more than just symptom relief. That’s one of the reasons I’m doing this video series. As Harvard put it, stents are for pain, not protection. But then, unbelievably, it was discovered that stents may not even help with pain, as revealed in this double-blind, randomized controlled trial. Wait, you can blind people to the active treatment in drug trials by giving them a placebo sugar pill, but wouldn’t you kinda notice if you got surgery or not, whether or not they cut into your groin? Not if you got sham surgery—placebo surgery—where they cut into everyone, thread up the catheter, and at the last moment, randomly actually do or do not actually place the actual stent. And those who got the fake surgery did just as well as those who got the regular surgery. Wait, there are no benefits to angioplasty and stents outside of an emergency setting? Doesn’t prevent heart attacks, doesn’t enable you to live longer, and doesn’t even help with symptoms? And since the procedure carries risks—including death—maybe stents should be used only for people who are actively having heart attacks. But wait, so hundreds of thousands of people are getting these operations for nothing? How do the doctors justify it? Is it just greed? How do they get patients to sign up it? Do they just not tell them the truth? And wait, why doesn’t it work? After all, you are opening up a blocked artery. There are just so many questions, which we’ll start addressing next.

Please consider volunteering to help out on the site.

Video production by Glass Entertainment

Motion graphics by Avocado Video

Doctor's Note

Hold on. Why doesn’t opening up—and even propping open—a blocked coronary artery help? I address that next. This is the first video in a seven-part series on stents. Stay tuned for:

All of these videos are available on a digital download of a webinar I did last year, which also includes a series on statins. You can find it here.

UPDATE: A new meta-analysis was just published last month and alas, there is still zero survival benefit to stent placement for stable coronary artery disease, but at least there were fewer heart attacks. Since this still didn’t translate into actually living any longer, the foundation of treatment remains medical and lifestyle management. Hat tip to Dr. Bitterman!

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