Medication or angioplasty? Two approaches to treating heart disease are at the center of a heated debate

In recent weeks, there has been continued discussion about which is more effective, medication or angioplasty, when it comes to dealing with certain forms of heart disease. Here's what a controversial, five-year study of more than 2,000 heart patients revealed:

According to researchers and other medical experts, the study indicates that for some heart patients with chronic chest pain, conventional drug treatment is just as effective as artery-opening angioplasty that sometimes includes the insertion of a metal stent to keep the arteries open.

At the conclusion of the study and contrary to popular thought, researchers found no significant differences between those who used medical therapy and those who elected angioplasty, the procedure in which a tiny balloon is inserted to unclog arteries. But doctors point out that the study focused on those patients with non-emergency chronic angina, and that the study's results shouldn't be applied to the use of emergency angioplasty to stop a heart attack.

The researchers and others stressed that angioplasty clearly benefits patients who are in the midst of a heart attack or are at very high risk for one. But the data indicate that for a patient whose condition is stable, medical therapy is just as effective at reducing the major risks.

In a closer look at the study that analyzed angioplasty patients and those who relied solely on medication, the rates of death, heart attacks and strokes, hospitalization rates for heart attacks and hospitalization for worsening chest pain were practically the same.

Doctors say the results of the study is good news for patients, especially from a financial standpoint. "This [study] considerably changes the scope of things, especially since more people are living longer," says Fred L. Daniels, M.D., a Chicago physician. It's estimated that more than 1 million angioplasties are done each year and more than half of those are performed on patients who have chronic chest pain.

The immediate fallout, medical experts say, will be a number of patients who will avoid the expensive angioplasty procedure and, in consultation with their physicians, choose to treat their artery disease with drugs, including statins and a variety of drugs that prevent high blood pressure.

With this new information, the multibillion-dollar industry that produces stents will probably be most affected. The use of stents has increased substantially during the past 10 years to treat heart disease, but doctors say choosing drug therapy instead of angioplasty could account for as much as $10 billion a year in medical savings.

Heart disease continues to be the No. 1 cause of death among African-Americans. According to the American Heart Association, the risk for heart disease is 1.5 to 2.4 times higher for people who are inactive compared with those who are physically active on a regular basis.

Facts About Heart Disease

Blacks are 1.5 times more likely to die from heart disease than Whites.

The most common symptoms of heart disease are chest pain (also called angina), shortness of breath, a rapid heartbeat, weakness, dizziness, nausea and increased perspiration.

Angina usually begins in the chest, but it can also start or spread to different areas of the body, such as down the left arm (the most common site), the left shoulder, the neck or lower jaw, the mid-back, down the right arm. Some people may experience tingling or numbness in the arm, hand, or jaw when angina is present.

Heart attack symptoms in men and women often differ. Men usually have the typical type of chest pain that comes with exertion and subsides with relaxation. Women, older adults, and people with diabetes may have symptoms such as heartburn, nausea or fatigue. Doctors say chest pain doesn't always have to be present.

In one study, several women reported warning symptoms a month before having a heart attack. These symptoms included unusual fatigue, sleep problems, and shortness of breath. Only 30 percent reported chest pain, a symptom reported by the majority of ment who have heart attacks.

Doctors say some people who have coronary artery disease and insufficient blood flow to the heart muscle (ischemia) have no symptoms at all. The condition is referred to as "silent ischemia." In some cases, a person can even have a "silent heart attack," which is one without symptoms.

A heart-healthy diet, regular physical activity, eliminating smoking and exposure to secondhand smoke, controlling diabetes and a commitment to follow your doctor's recommendations are all part of reducing your risk for heart disease, heart attack and stroke.

COPYRIGHT 2007 Johnson Publishing Co.
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