One treatment we now have for many coronary heart disease patients is the stent. Questions remain about the stent, though.
1. Are stents effective in heart disease? 2. Are stents effective in heart disease long term? 3. Are stents more effective in heart disease than other treatments?
What a Stent Is
A stent is a tiny tube made of wire metal mesh. This tube is inserted into a partially blocked artery to prop it open and allow blood to flow more freely.
How a Stent Is Inserted
Surgery is not needed to insert a stent for heart disease. A stent is usually placed during angioplasty. In angioplasty without a stent, a small balloon at the tip of a catheter is inserted into an artery (usually in the groin) and inflated to force open a blocked area inside the artery. If the physician believes the balloon is insufficient, and a stent is needed, the stent is collapsed to a small diameter and put over the balloon catheter. The doctor then moves the stent and balloon up the artery to the blocked section. The balloon is inflated, and as it inflates, it makes the stent expand. The expanded stent is locked in place, and forms a supportive framework that holds the artery open. The balloon and catheter are removed.
Time a Stent Remains in Place
A stent is permanent. It is intended to remain in the artery, holding it open. The expectation is that it will improve blood flow to the heart and relieve heart disease symptoms for years.
Over those years, though, are stents effective in heart disease treatment? Or do they present potential problems?
Effectiveness of Stents
Within a few weeks of the time a stent is inserted, the artery's inner lining begins to grow over the metal surface of the tiny tube. This growth tends to block the artery again. Additional plaque may also build. When this happens, the artery closes at the same place, and heart disease symptoms return. The most notable symptom is probably chest pain.
In an effort to avoid this growth, pharmaceutical companies developed a new stent to replace the bare metal stent. The new stent is coated with drugs that release slowly. The drugs help keep the artery from closing again. In either case, the patient must take anti-clotting medications, but it is hoped that the newer stents may be effective long term.
Stents Versus Other Treatments
The final question is, of course: are stents more effective in heart disease than other treatments? Many prescription medications have been developed for the treatment of coronary heart disease. Suppose a patient opted to forego the stent and rely solely on medications. What then?
A landmark study published in March 2007 showed that, after 5 years, heart disease patients who had stable angina, and were treated only with prescription medications and aspirin, did just as well as those who had a stent placed in an affected artery. They survived at the same rate. Those with stent placement had more immediate relief from angina pain, but that playing field leveled over time.
The study discovered that more than half of heart disease patients who get angioplasties - 1 million plus annually - have stable heart disease. That means they would do just as well with medications as they would with stents. The authors of the study said that as many as 85 percent of all stents placed are unnecessary. In the U.S., the cost per patient of placing unnecessary stents is between $30,000 and $40,000.
Stents are effective in heart disease treatment, but medication is just as effective in patients with stable angina.
The Decision Maker
The decision maker is usually an interventional cardiologist. An interventional cardiologist is the one who performs angiography, the most prevalent test to see if an artery is blocked. He or she will require the patient's written permission, prior to angiography, to insert a stent immediately if blockage is found. In other words, the interventional cardiologist will be the decision maker for the heart disease patient.
The patient has no opportunity to discuss the severity of the blockage or the possibility of treatment other than a stent. Unfortunately, interventional cardiologists are showing signs of reluctance to give up stents. The patient will have to make a firm decision before angiography, and withhold permission if treatment with medication is preferred.
Disclaimer: The author is not a physician, and shares this research for educational purposes only. Please ask your physician about whether stents are effective in heart disease.
But, there are ways to avoid heart disease, if you understand the associated health issues and how to control them. Here's an overview of the contributors to heart disease and how to minimize your risk by managing your life.
High Cholesterol
Cholesterol comes in two forms. LDL cholesterol (low density lipoproteins) is what is known as "bad cholesterol". When too much LDL circulates in the blood, it can build up in the inner walls of your arteries, where it forms plaque that hardens and narrows the arteries. This condition is called atherosclerosis.
Narrow arteries make it easy for a clot to form and cause a block, and they also restrict blood flow. Peroxidation is the process that turns the cholesterol into the hard plaque that sticks to arterial walls.
HDL cholesterol or (high density lipoproteins) is what we refer to as "good cholesterol". HDL cholesterol carries bad cholesterol away from the heart and deposits it to the liver so that it can pass from the body.
We need this cholesterol to be high, because it protects us. When your HDL levels are too low, the LDL cholesterol is in control.
It's important to understand your cholesterol levels and do your best to improve them if they're not where they should be. Dietary cholesterol comes from animals and animal products. Eating a diet that's low in saturated fat and cholesterol; avoiding things like butter, egg yolks and red meat, can help lower your LDL levels considerably.
When you eat fat, make it the sort that raises your HDL levels, by including olive oil, canola oil and nuts in your diet.
Your cholesterol level is also affected by your heredity. Some families just have higher cholesterol than others, regardless of how much they watch their diet.
If you fall into this category, you may need medication in addition to a healthy diet to get your cholesterol numbers in line.
High Blood Pressure
The second important component in heart disease is blood pressure. High blood pressure has no symptoms, but it can lead to heart disease, stroke and kidney failure if unmanaged.
The pressure of your blood puts beats against the walls of your veins and arteries. This weakens the arterial walls and causes stress on the heart.
The pressure can also cause little nicks in the arterial walls. Your body tries to repair these nicks by creating little blood clots. However, if these clots become too big, or break off and get stuck in an artery (particularly one already narrowed by plaque), it can result in a heart attack or stroke.
That's why keeping your blood pressure under control lowers your risk of heart disease. Have your blood pressure checked regularly to determine if you're at risk. A healthy blood pressure is one that is right around 120/80.
The Big Five
To get your lifestyle under control and manage your blood pressure and cholesterol levels so that you can minimize your risk of heart disease and stroke, there are four things you need to do.
Exercise
Exercise is critical for preventing heart disease. Get at least 30 minutes of physical activity at least 3 times a week. Regular exercise lowers cholesterol and blood pressure naturally, and can help keep your weight in check.
Eat Right
Reduce the amount of saturated fat in your diet. Instead, focus on eating fruits, vegetables, whole grains and lean protein like fish and chicken. If you're overweight, get down to a healthy weight for your height. A heart healthy diet will help you lose the extra pounds, too. Avoid processed foods with ingredients like enriched flour and high fructose corn syrup.
Don't Smoke
Smoking significantly increases your risk of high blood pressure, heart disease, stroke and cancer.
Get Those Anti-Oxidants
In the last few years, we've come to understand how powerful anti-oxidants are in the fight against disease. Anti-oxidants fight the free radicals that our body creates each day as we process our food.
Without anti-oxidants to fight them, these free radicals damage our bodies' cells and DNA. This leads to disease and premature aging.
If you're eating a heart healthy diet, you're probably already getting a fair amount of anti-oxidants already, since fruits and vegetables are very good sources. However, there are a few anti-oxidant powerhouses that you really should add to your diet. Be sure you're getting:
The Best Fruits and Veggies - Artichokes, blueberries, red beans, pomegranates and tomatoes are potent anti-oxidant sources. If you're not eating these regularly, add them to your diet.
Green Tea - Research has shown that the flavonoids in green tea, particularly EGCG, are some of the most potent anti-oxidants around. There have been many studies that have associated green tea with a lower risk of heart disease. In particular, one study reported on UK Tea Council showed green tea to have a positive effect on many aspects of heart disease.
This study reported that green tea helped lower cholesterol, had anti-inflammatory properties, protected arteries and blood vessels and protects against blood clots. This information is powerful when you consider how simple it is to add green tea to your diet.
So, arm yourself with the weapons to beat heart disease before it's too late. Heart disease can be prevented with a healthy lifestyle - so make sure you're prepared to avoid this serious killer.
Both Anna Hart & Marcus Stout are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.
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