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Heart study confuses patients, doctor says

Becky Bosshart
Appeal Staff Writer

After news broke last week about a study to be published in the New England Journal of Medicine, cardiologist Anthony Field received many concerned calls from patients.

The topic of the study was an issue that’s vital to every heart patient: treatment. Those who suffer from heart disease have seen a lot of information released in the last few months about methods of treatment.

The results of the study suggest that surgical repair of a blocked artery can be just as effective as using prescription medicines. This could cause concern in those who had a surgery done to repair a blocked artery, or who are expecting to undergo surgery.

Field said it’s important to note who this study was conducted on: those with chronic stable angina. That means the study was meant for those who can keep themselves healthy and stable through exercise and prescription medicines.

People like Jerry Allen, 61. Five years ago one of his arteries was 90 percent blocked.

“The doctor told me I have to treat this aggressively and I decided to do that by exercising every day and taking medications,” Allen said Thursday. “And I feel fine.”

His cholesterol-lowering medicine Lipitor, Toprol and vitamins cost about $80 a month. But he has no need for surgery.

Surgery is often reserved for those patients with impending heart attacks, or who don’t respond to medicine. Field said most angioplasties and stent therapies are done in people in this unstable coronary situation. These types of patients were not included in the recent treatment study.

“The bottom line is that this study is not new information,” Field said. “We have been choosing the people for various forms of therapies this way for decades.”

What about the controversy surrounding coated stents?

This one raises concern. The FDA recently reported findings that a type of medicine-coated stent intended to help prevent blood clotting may actually do the opposite.

“An evolution of stent technology solved a problem – but in a very few it creates a big problem,” said Field, of Carson Cardiology.

A patient who has balloon angioplasty done to treat a blockage has a 40 percent likelihood of needing a second procedure. Bare metal stents introduced in the early 1990s reduced that need for another surgery to 15 percent. Coated stents lowered the need to less than 1 percent.

“The problem with coated stents is that they could clot at an incidence of one in 1,000, or less,” Field said. “That is a dramatic event – leading to a heart attack and possibly death.”

Other reports said it could be five or fewer clots in every 1,000 patients. The solution presented by doctors is to take the anticoagulant drug Plavix. The problem: it costs $150 a month, and $100 a month for the generic.

More studies are needed, and patients often aren’t anxious to keep taking such an expensive drug, Field said.

Glossary

angioplasty – surgical repair or unblocking of a blood vessel, especially an artery, can use a balloon to open clogged arteries

stent – a metal support placed inside a blood vessel to relieve an obstruction

medical therapy – a treatment of medicine, which often incorporates nitroglycerin, beta blockers, cholesterol-lowering medicines and aspirin

• Contact reporter Becky Bosshart at bbosshart@nevadaappeal.com or 881-1212.