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Stents Do Little to Prevent Heart Attacks

A recent study finds that stents do not prevent heart attacks as considered. Doctors treat patients with stents to minimize chest pains and to prevent heart attacks//. Stents are hollow tubes implanted surgically into blocked arteries to keep them open.

This landmark study funded by the U.S. Department of Veterans Affairs, confirms that stents do improve blood flow but are no more effective in preventing heart attacks than that is possible by drug therapy alone. According to statistics, an astounding 800,000 Americans are fitted with stents every year.

The Clinical Outcome Utilizing Revascularization and Aggressive Drug Evaluation, or COURAGE, study studied more than 2,200 patients with blocked artery and persistent chest pain. It found that patients treated with usual drugs like high doses of statins, medications to lower blood-pressure and aspirin showed the same progress as those who received drugs and stents.

"It does not relieve risk of heart attack and it is only marginally better at relieving angina, so why should you go on stenting?" said Steve Nissen, president of the American College of Cardiology. "We should reserve it for those that just don't do well on medical therapy or if they have symptoms that are interfering with lifestyle," he added.

"What happens when you put a stent in is you're attacking one narrowing in the artery, but it's not the narrowing that's going to cause the next heart attack," he explained. "It's the plaque developing everywhere else that's going to cause the next heart attack and that's what the medicines treat."

"From my standpoint, it validates what was known since the inception of angioplasty — that it relieves symptoms," says William O'Neill, executive dean for clinical affairs at the Miller School of Medicine at the University of Miami. Still, he feels the study will result in decline in usage of stents because doctors may feel that they are overused.

Lead author Dr. William Boden, chief of cardiology at Buffalo General Hospital argued, “The results show they should try medication first.” He said,"I think the results will be profound in terms of how it changes the practice of cardiology in medicine."

Stenting is now a $6 billion industry and doctors who perform angioplasty defend it saying it has its advantages. The shares of Boston Scientific drop by 10 percent and those of another major stent manufacturer Johnson & Johnson are down by 5 percent.

Last night at a Boston Scientific event, Dr. Martin B. Leon, a Columbia University cardiologist, railed against the study, prompting the officials to take action as results were released early and to issue a statement that it will be "considering strong sanctions against the individual or individuals involved."

Boden advise patients to have a discussion with their doctor about their symptoms and not decide on their own. He fears that many patients may decide to try drug therapy for months before going for other options.

The American Heart Association guidelines clearly state that patients should be treated with medications first before employing stenting or procedures like bypass surgery.
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