Heart Patients Seek Guidance on Stents, Statins

FRIDAY, March 30 (HealthDay News) -- A number of controversial findings presented during the American College of Cardiology meeting this week has probably left many heart patients scratching their heads over which treatment is best for their particular cardiovascular condition.

Experts note the answer has never been easy, and what works for one heart patient might not work for another.

"I think that we sometimes try and make things too simple, in the media and in the scientific community," said Dr. Stephen Siegel, a cardiologist at the New York University Medical Center in New York City. "The goal is to translate that information from evidence-based medicine, to take care of each patient."

One study overturned the long-held notion that surgical techniques such as angioplasty and stenting were better than drug therapy at treating stable heart disease. Other studies questioned the usefulness and safety of expensive, drug-coated stents. And other trials trumpeted the expanding benefits of statins, raising the question of who shouldn't be taking these drugs.

Take the angioplasty-vs.-drug therapy debate. The study of almost 2,300 patients found no differences in death, nonfatal heart attacks, strokes or hospitalization between patients with "stable" heart disease treated with medication alone vs. those who got drugs plus angioplasty and stenting.

While many cardiologists welcomed the findings, stent manufacturers and some interventional cardiologists (doctors specializing in procedures such as angioplasty) said the study was biased in favor of drug therapy. The trial was overseen by U.S. and Canadian health agencies but did receive funding from the pharmaceutical industry.

However, Dr. Raymond Gibbons, president of the American Heart Association, said the study simply "challenges an assumption that has often been present in both patients and doctors, which was that doing an angioplasty and stenting a blockage would reduce the chance of death and heart attack," he said. "The trial clearly shows that that is not the case."

Gibbons, who is also professor of medicine at the Mayo Clinic in Rochester, Minn., stressed that the trial had to pass muster not only with the ACC but with the tough peer-review board at the New England Journal of Medicine, which published the results this week.

"Mayo, where I work, was a center in this trial," he added. "If we had had any concerns about the study's design, we would not have participated."

Gibbons stressed that the findings only apply to patients with chronic but stable heart disease. These patients may experience intermittent chest pain (angina) but have no history of heart attack.

"We need to recognize that the study does not apply to acute heart attack [patients]," he said. The study also does not apply to patients with stable heart disease whose chest pain has not responded to medicines, Gibbons added. Both of those groups are very appropriate candidates for invasive procedures such as angioplasty, he said.

According to Siegel, in too many cases, patients with stable heart disease are routinely sent off for an angiogram. And once doctors notice an obstruction -- any obstruction -- their temptation is to surgically remove it.

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