Angioplasty Vs. Drug Treatment Controversy

[klikster]

A couple of weeks ago, I had a cardiology exam at Bamrungrad, nothing definitive, but 'angioplasty' was referenced as something that could possibly be required pending ... I've had no pain symptoms, but don't have so much endurance. Actually, my endurance totally sucks! I'm significantly (30 kg) overweight and terribly out of shape, and will turn 68 next month. I also have elevated BP (160/75).

A headline concerning a study and report called the "Courage Report" that caught my eye:

"Angioplasty No Better Than Drug Treatment in Long Run" at US News & World Report

The gist of the article:

There are some advantages to artery-opening angioplasty over drug treatment for people with heart disease, but those advantages disappear within three years, according to the latest report on a pivotal study on the subject.

Another article claimes the "Courage Report" has " .. set off a media firestorm of misinterpretation, causing confusion for patients and physicians." at Angioplasty.org

A supposedly unbiased comment from the angioplasty.org article said:

"A balanced interpretation came from Dr. Gregory Dehmer, president of a leading professional organization, the Society for Cardiovascular Angiography and Interventions (SCAI), who told Angioplasty.Org that the study was not "a huge revelation, but more a penetrating glimpse at the obvious." The SCAI itself issued a press release, stating it was unlikely that the study results would alter the approach for treating patients with chronic stable angina."

Which leaves a lot unsaid.

Are there any health care professionals here who have an opinion?

[benjamat]

Not a health care pro but,

Ten years ago I had an MI and on being hospitalised they decided to insert 2 stents.

I have had no problems since this time.

My question, if angioplasty ineffective after 3 years why not have stents inserted, it is essentially the same simple process.

In the end all you want to do is to keep the blood flowing.

[zzdocxx]

No.

Seriously though, I am not hearing that you have angina?

Might be a good idea to try to pin them down on exactly what it was that they were thinking of, it is easy to misunderstand when there is alot of medical jargon being thrown around.

Meanwhile, it sounds like at the time of the exam, you were not being optimally treated "medically", that is with medications. Because your BP is too high. Maybe you have some other issues too.

I suppose you need to find out to what extent you can exercise. The reason it is beneficial is that the blood supply to the heart develops "collateral" circulation. Ie. extra routes for the blood to get there, which is good if some of the main coronary blood vessels have become narrowed by atherosclerotic plaques. But I don't mean killing yourself all at once in one day at the gym.

OK that's about as much as I can tell you.

My brother the veterinarian says that a telephone diagnosis isn't worth the paper it's printed on. Same goes for the internet.

[chiang mai]

I had angioplasty earlier this year and followed the debate regarding medication vs stents. For someone who suffers from angina, angioplasty is the prefered way forward since it relieves pain and opens the artery. But for someone who is pain free yet still has blockages in excess of 85% the findings are that the death rate is identical between those who have had stents inserted and those who have been put on blood thinners such as Plavix and/or Aspect. It is true that around one third of patients who have undergone angioplasty suffer from some form of restenosis (re blocking) but the remainder it seems can remain blockage free (providing you adjust your diet, exercise and control your cholesterol). For me the decision to go with angioplasty, despite not suffering any symptoms and despite having been on Plavix for a year, was geared towards being able to give up Plavix at some point.

[thai thai]

Being 60 years old and concerned about plaque buildup in my arteries, I just finished reading an excellent book regarding heart disease by a famous US Cardiologist...here's the link if interested...

http://www.heartattackproof.com/

[FBN]

Angioplasty is an invasive procedure with significant risks. It has to be fully justified. In other words, you have to have a positive stress test at least and other risk factors such as high cholesterol etc etc.

It is difficult to assess the basis for this recommendation as we, the posters here, do not have full info but please be sure that there is sufficient reasons to do this.

I don't want to sound too sceptical but I know of more cases at Bumrungrad where this procedure was recommended without proper investigations..

Focus first on getting your weight under control and the cholesterol with it, if it is a problem.. Gradually work on your excercise and endurance and get a second opinion.

[klikster]

Angioplasty is an invasive procedure with significant risks. It has to be fully justified. In other words, you have to have a positive stress test at least and other risk factors such as high cholesterol etc etc.

It is difficult to assess the basis for this recommendation as we, the posters here, do not have full info but please be sure that there is sufficient reasons to do this.

I don't want to sound too sceptical but I know of more cases at Bumrungrad where this procedure was recommended without proper investigations..

Focus first on getting your weight under control and the cholesterol with it, if it is a problem.. Gradually work on your excercise and endurance and get a second opinion.

I'm a real believer in the "less is more" concept. My cholesterol is very normal .. actually, pretty much everything is normal except my BP. Stress test dam_n near killed me! I'm on a relatively strict diet, taking BP meds and exercising.

I've delayed my next appointment so that my diet and exercise can actually make some difference. One thing the Dr said was that my high BP may be genetic.

[zzdocxx]

What was the result of the stress test, apart from almost killing you?

[klikster]

What was the result of the stress test, apart from almost killing you?

Inconclusive.

[JAS21]

What was the result of the stress test, apart from almost killing you?

Inconclusive.

Speaking from experiance the only sure way is an angiogram, however I was at BNH yesterday and found out they have a CT Angiography machine. If I understand correctly if produces the same or better information. You go in a CT Scanner type machine for 30 minutes so they said. Might be worth getting opinion from someone else. Normal price 17500Baht

[zzdocxx]

OK how are you doing with your blood pressure and so forth?

Is there someone now who is managing your health issues?

I just don't see you needing any interventional procedure if you don't have symptoms at this point.

[benjamat]

The UK goverment has announced today that angioplasty and stenting is to be given as main treatment instead of drug therapy. Now if you have severe angina or MI you will be taken to hospital for immedaite angio, even as emergency and 24/7.