Lifelong Health by Dr. David Lipschitz

Thanks to the CAT scan, cardiologists can detect narrowing of the coronary arteries with impressive precision. Whether the patient has chest pain, experiences breathlessness or is completely asymptomatic, the CAT scan is used as a major tool in the fight against heart disease. Because the scan offers such a detailed view of the heart, previously unrecognizable blockages or the buildup of calcium are likely to be treated with aggressive therapy.

In many cases where blockages are detected, the initial screening leads to the more invasive angioplasty, in which the artery is dilated and kept open by inserting a stent. The overall treatment plan can be aggressive, fast-paced and — as is the case whenever dealing with your heart — extremely intimidating for the patient. If you have coronary artery disease, learning to make measured and educated decisions is perhaps the most difficult and yet most important challenge of your life.

While the treatment plans can vary significantly based on symptoms (or lack thereof), for patients with stable chest pain a recent article published in the New England Journal of Medicine provides important guidance about how coronary artery disease should be treated.

Previous research had shown that dilating the artery with a stent, or angioplasty, did not offer any benefit over treatment with medications in reducing the risk of a heart attack or prolonging life. However, there were many physicians who believed that angioplasty led to more symptomatic relief and, therefore, a higher quality of life. In this particular study, researchers sought to determine if conducting an angioplasty combined with ideal medical management added any benefit over medical management alone.

The results revealed that after three months, slightly more patients who received the angioplasty were symptom free (53 percent compared to 42 percent of those receiving medical management alone).

However, the benefit of improved quality of life through the addition of angioplasty was minimal and not clinically significant. Both approaches to treatment equally and dramatically improved quality of life.

So, here is the issue: If the angioplasty and the medical management provided yield virtually the same results, which do you choose? This is where being an educated consumer of health care becomes vitally important.

First, angioplasty is very expensive and can exceed $30,000.

In addition, the procedure is not without risk.

In an accompanying editorial to the study reported in the New England Journal of Medicine, Drs. Eric D. Peterson and John S. Rumsfeld point out that for every 1,000 angiograms undertaken, two patients will die, 28 will have a heart attack, 60 to 80 would be transiently improved by being treated with medications, and 800 would see neither harm nor benefit. If 800 of 1,000 patients see neither harm nor benefit, why do it?

Conventional wisdom holds that angioplasty is the most effective way of correcting an occluded blood vessel, relieving chest pain, improving quality of life and reducing the risk of heart attack and stroke.

However, even if an angioplasty is done, treatment with medications is needed. The Journal's editorial states that patients with stable chest pain should, under most circumstances, be optimally treated with medications alone, reserving angioplasty for those in whom medical management fails.

If you have coronary artery disease, it is essential that you be fully educated about every aspect of how to prevent and treat your illness. If you are concerned about heart disease, think twice before having a CAT scan of the heart to screen for illness. There is no scientific evidence to support using a CAT scan of the heart as an initial study to identify coronary artery disease.

Dealing with heart disease can be a very frightening and intimidating process. However, do not let that prevent you from being an educated consumer. If a cardiologist tells you that you need to have surgery, ask why. What are the benefits? Will it prolong your life?

Will it reduce your symptoms more than medical management alone? What, if any, lifestyle changes can you make to reduce your risk of heart attack? Ask questions, demand answers and do not act in haste. This is the best way to assure rational, quality and evidence-based care.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

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