Medication, Lifestyle Changes
May Be As Effective As Stenting

A balloon flattens plaque against the artery walls during balloon angioplasty. A stent is permanently placed in the artery to hold it open.

You have chest pain (angina) or other troubling symptoms, but you're not suffering a heart attack. Your doctor performs diagnostic tests and finds that you have a blockage in one of the arteries that supplies blood to your heart.

In the past, your doctor may have suggested that you undergo an angioplasty and stent procedure to open the blockage and improve blood flow to your heart. New evidence, however, suggests that you may have another equally effective noninvasive alternative.

Researchers studied nearly 2,300 patients with stable coronary heart disease (CHD) -- clogged arteries nourishing the heart -- as part of a major clinical trial called the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation, or COURAGE Trial. Specifically, they compared the outcomes of patients treated with stenting procedures with those who had medication therapy and lifestyle intervention only.

Study Yields Startling Results
The researchers found that aggressive medication therapy and lifestyle changes were just as effective as stenting procedures in preventing future cardiac events or premature death in patients with stable CHD.

"We now have evidence that taking care of one blockage with a stent doesn't fix the overall problem," says Mauricio E. Melhado, MD, a cardiologist at Wellington Regional Medical Center.

"Medication also plays an important role because a blockage is just the tip of the iceberg. Plaque tends to build up in vessels throughout the body."

Stents Not for Everyone
About 1 million Americans have stent procedures every year. Coronary angioplasty and stents remain the treatment of choice for heart attack patients. But as many as four out of 10 stent procedures performed every year are elective procedures in patients with stable CHD.

"Stents can cause problems," says Dr. Melhado. "Many patients develop scar tissue around the stents and need additional procedures in the future. In addition, there's a risk that the stent will close completely if patients stop taking aspirin before having dental or surgical procedures."

Medical Therapy Key
This recent research suggests that a medication regimen that includes aspirin, anti-angina drugs and medications to control high blood pressure and high cholesterol can help relieve symptoms in many patients with stable CHD. Lifestyle changes, including smoking cessation, losing excess weight and eating hearthealthy foods, also may help.

"Many patients who take medications and make lifestyle changes find that their symptoms get better without interventional procedures, so they don't face the risk for complications that can occur with stents," Dr. Melhado says. "And these noninvasive treatments often improve the health of blood vessels throughout patients' bodies."

But he also notes that angioplasty and stents may be an option for patients with stable CHD who have blockages located in specific areas or whose symptoms persist after taking medications and making lifestyle changes.

If you have symptomatic but stable CHD, talk with your doctor about your conditions and which treatment options may be best for you.

For more information about cardiology services at Wellington Regional Medical Center, please call 561-333-8450.

Mauricio E. Melhado, MD, FACC, is board certified in invasive cardiology with additional board certifications in internal medicine, nuclear cardiology and echocardiography. He is an associate of Cardiology Partners of the Palm Beaches along with Drs. Foucauld, Venugopal, Vedere and Shah with an office on the hospital campus. For more information, please
call 561-333-8450.

Wellington Regional Medical Center, 10101 Forest Hill Blvd. Wellington, FL 33414 (561) 798-8500