Stents work to reduce chest pain—but are they better than drugs?

For years, patients with angina (chest pain) caused by blockages in the arteries have been treated with medications. When medications alone aren’t enough, cardiologists have turned to stents—small mesh or plastic tubes inserted into an artery to keep it open. However, a study published in The Lancet suggests that stents are not superior in alleviating chest pain when compared to drugs, which has patients and doctors alike questioning whether stents have a role in treatment plans for ongoing chest pain.

It’s troubling that this study is receiving so much press, because the main takeaway is not new: For most patients, medical treatment will respond to some degree of chest pain relief, but the best drugs in the world will not open the blockages. Stents do.

Stents aren’t the best treatment for everyone. This is a commonly known fact—as with any condition, there is no catch-all treatment for angina, which is caused by fatty plaque buildup that narrows the arteries and blocks blood flow (stenosis or atherosclerosis). But for someone with a severely blocked artery, a stent can stop their chest pain faster and lower the risk of reducing blood supply to the heart muscle.

Though the study may cause some people to question the need for stenting, I don’t foresee it making waves in cardiology due to a few concerning elements.

Concerns with the stents study

Three key issues about this study jumped out at me:

  • The participant pool: With just 200 patients, the data pool is too small for the findings to be considered statistically significant.
  • The timeline: Data were collected over six weeks, which is too short a window to draw solid conclusions in terms of risk reduction.
  • Baseline: Patients at baseline were not that sick at baseline. Patients at the beginning of the study had a good exercise capacity, so it was not that hard to treat them with medications to improve their symptoms.

A better study, published in 2007, was the COURAGE study. It compared PCI, or percutaneous coronary intervention (angioplasty with stenting) to optimal medical therapy. The study was conducted over nearly five years with more than 2,200 patients and provided long-term, statistically relevant information. The study found that treatment with stents did not reduce the risk of death or heart attacks at five years, and medication alone was about as effective as medication plus PCI for the initial treatment of stable coronary artery disease. This does not mean PCI doesn’t work. Stents do reduce chest pain and are usually prescribed at MedStar Heart & Vascular Institute for patients who do not respond initially to medical therapy or when medication alone isn’t enough to control the disease symptoms.

Who is a good candidate for stents?

Many cardiologists, myself included, prescribe medication alone before recommending stents for patients who have moderately blocked arteries, minimal chest pain and a low risk for a heart attack in the near future. Some patients can safely choose between medication alone and medication plus a stent, depending on their symptoms and how blocked the artery has become. Often, these patients will opt for the stent.

But an artery that is 80 percent or more blocked is like a ticking time bomb in terms of heart attack risk. When a patient’s artery is that blocked, I don’t feel comfortable risking their life on medication that might not be effective on its own. In those cases, I’ll recommend a stent to reduce their risk of a cardiac event. We need to remember that drugs do not open the blockage and drugs may have side effects.

While not everyone needs or should have a stent, the study in The Lancet does not indicate that the therapy is ineffective. Rather, it illustrates the need for doctors and patients to work together to determine the most effective therapy for their unique condition instead of applying generalized standards to everyone’s care. If you have a stent and are concerned, or if you’re thinking about getting one, call 202-877-3627 for an appointment with one of our MedStar Heart & Vascular Institute cardiologists.

One Night at the Theater, CPR was the Star

Edward Cornfeld, MD, a former Ob/Gyn from Rockville, Md., is one lucky man. At 87, the avid swimmer sits in the warm sun of his bright kitchen and thinks back to last June 18. “I remember waking up briefly in the ambulance, but that’s about it,” he says.

What he doesn’t remember is a heart attack that began just before a performance of District Merchants at Washington, D.C.’s Folger Theatre early this summer. The event was meant to be a fun, relaxing evening with three friends. As the players warmed up the crowd and bantered with audience members, Dr. Cornfeld’s breathing became restricted, and he collapsed on the gray stone of the intimate theater.

In the balcony, Michelle Michaels heard the cries for help. A nurse practitioner and former employee of MedStar Washington Hospital Center, Michaels says she assumed a doctor would certainly rush to help. “I waited for a minute,” she recalls. “There are doctors everywhere, so I assumed someone would help.” When she realized that no one was moving, she dialed 911 and, to her surprise, was the first to report the incident. After providing basic information, she rushed down the balcony steps, through the lobby, and on to the orchestra floor where she began administering CPR to Dr. Cornfeld.

Sitting nearby, Dylan Mehri, a student at Oberlin College in Oberlin, Ohio, debated leaving his seat and offering his help. He recalls thinking, “I’ll probably just be in the way. Someone else must be coming to help, right?” When no one appeared, Dylan got up. “I didn’t realize what I was doing at first,” he said. “I just took my CPR card out of my wallet and told the woman, Michelle, that I knew CPR and could help.” He knelt by Dr. Cornfeld’s side and began compressions.

According to the American Heart Association, 100 compressions a minute are recommended to best mimic a heart rate and keep blood flowing throughout the body to keep oxygen circulating to the brain.

Michelle shouted to the crowd of onlookers, “Is there an AED or a stethoscope or anything here we can use?” A staff member brought an AED (automated external defibrillator), and Michaels applied the panels to Dr. Cornfeld’s chest. Operating under the instructions of the machine, she administered a shock, then Mehri maintained hands-only CPR until the ambulance’s emergency medical technicians (EMT) arrived a few minutes later.

And that was the key. Those six to seven minutes that Dr. Cornfeld was unconscious were critical. “Time is life,” says Paul Corso, MD. “Had Michelle and Dylan not acted with the speed and knowledge they did, it is quite possible Dr. Cornfeld would not be with us today.”

Dr. Corso, chairman of Cardiac Surgery for MedStar Heart & Vascular Institute at the Hospital Center, performed quadruple bypass surgery on Dr. Cornfeld a few days after he was stabilized. Dr. Corso says that because Dr. Cornfeld swam every day and did some light work with weights, he was an excellent surgical candidate with a strong chance for recovery.

And while Dr. Corso performed the lifesaving surgery, he still gives most of the credit to the good Samaritans who acted that day. “EMTs aren’t everywhere,” he says. “The more people who take the time to get certified in CPR and implementing an AED, the more people will be saved.”

After several weeks of recovery at the Hospital Center under the watchful eye of Dr. Corso and a staff that Dr. Cornfeld praises as “being set up just for my recovery and anticipating my every need,” followed by another couple of weeks in a rehab facility closer to his home and family, Dr. Cornfeld is thriving.

With a strong grip on his coffee cup and a shimmer of vitality flashing across his face, he asks, “How do you repay someone for your life?”

Learn Cardiopulmonary Resuscitation (CPR) and Automated External Defibrillator (AED) Use

Sudden cardiac arrest can happen to anyone, at any time. With training, you can learn when and how to use an automated external defibrillator (AED) and to perform cardiopulmonary resuscitation (CPR).

MedStar Health’s Simulation Training & Education Lab, or MedStar SiTEL, is an authorized American Heart Association Training Center, which offers classes in Heartsaver® CPR/AED training and first aid for community members.

Classes are $50 to $85 per person and last three to six hours. If you’d like to host a course at your location, call Cheryl Camacho at 202-888-9181 or 443-239-1187 or email her at [email protected].

 

29 Things You Should Do for a Healthy Heart

You’re heard it many times before -- follow a healthy lifestyle for a healthy heart. Sounds simple, right?  But it’s not always so easy to pull off. A heart healthy lifestyle can reduce the risk for heart disease by as much as 80%!  But what is a “heart healthy lifestyle”?  It’s a commitment to many habits in our daily lives centered on our activity, diets, mindset and awareness.  There is no one “magic” thing. When lifestyle isn’t enough, talk with your doctor to set goals you can realistically achieve, such as losing weight or lowering your cholesterol or blood pressure levels. Sometimes, it takes medications that can be very helpful to optimizing your heart risk.

So, commit to making the many small lifestyle changes that make a healthy heart a snap! The key to success is to make small changes in many areas. No matter what you do, remember to take it day by day, and work to sustain your gains.

With that in mind, we’ve compiled 29 heart health tips. Knowledge is power!  Read on to find out what you can do to keep your heart healthy. Only you can love your heart. So start today!

1. Make time for exercise: Exercising 30 to 60 minutes on most days will cut your heart risk in half.

2. Know your heart disease risk: Calculate your risk by plugging your numbers into an online calculator.

3. Never ignore your chest pain:  Pain can be felt anywhere in the chest area, arms, your back and neck.

4. Check your blood pressure: Let the healthy blood pressure number be below 140/90. Both numbers matter!

5. No smoking: Don’t smoke, and ask your loved ones to quit.

6. Aspirin: Should you take aspirin? If you have heart disease, yes! If you don’t have heart disease, then maybe not! Ask your doctor.

7. Moderate exercise: How do you know whether you are exercising moderately? You should able to carry on a light conversation

8. Stress: Is it bad for your heart? Yes, sustained stress is, no matter the source. Learn to control your stress to prevent heart disease.

9. Second hand smoke is dangerous! Public smoking bans in the community have reduced heart attack risk by 20%.

10. Sex: Is your heart healthy enough for sex? Sex has a “heart workload” like climbing two flights of stairs.

11. Dark chocolate: Give your loved ones chocolate as a gift on Valentine’s day! Regular chocolate eaters have less heart and stroke risk!

12. Order wine with your dinner! Moderate intake is associated with lower heart risk. (Consume wisely!)

13. Red or white wine? Is one better for your heart? Wine, beer or spirits all show a similar relationship to lower heart risk.

14. The “Mediterranean diet” is the most heart healthy way to eat. Studies show this diet reduces heart attack risk up to 30%.

15. Mediterranean diet = veggies, fruits, nuts, seeds, grains, herbs, spices, fish, seafood, olive oil, poultry, eggs, cheese, yogurt and wine.

16. Take your heart meds fully and faithfully! It’s the only way to get the full benefit of the treatments!

17. Stairs burn twice as many calories as walking. Regular stair climbing reduces your risk of premature death by 15%!

18. The quantified self. Keep moving! Steps per day: Very active >10,000, active >7500, sedentary <5000.

19. Fish eaters have less heart disease! Think about fish as a first choice when eating out- let somebody else do the cooking!

20. Did you know that people who are optimistic have less heart disease? See the bright side- it is truly good for your heart!

21. If you snore, tell your doctor. Snoring can be treated, and could signal risks for your blood pressure and heart rhythm.

22. Want to really know your risk of heart attack? Get a calcium scan of your heart. Accurate, safe, and costs less than dinner for 2!

23. Do you know CPR? Simple! Learn it here and double somebody’s chance of surviving cardiac arrest. http://www.cpr.heart.org

24. Ditch the soda and energy drinks. Please.

25. Coffee lover? For your heart’s sake, it is OK! (But, skip the donut!)

26. Like music? So does your heart! Music listening lowers your heart rate, and blood pressure!

27. Are statin cholesterol drugs safe? For most patients, yes! Unfortunately, over the counter supplements aren’t very helpful.

28. Heart attack or stroke symptoms? Don’t delay! Call 911 immediately. Minutes matter to save lives!

29. Taking vitamins or other supplements for heart disease risk? Be careful- few have little, if any, proven benefit.

Have any questions?

We are here to help! Contact us for more information about heart health or to schedule an appointment. Call us at 202-877-3627.

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