New Research, FDA Advisory Focus on Stent Risks
According to American Heart Association data, cardiovascular disease accounted for 36.3% of deaths in 2004 (the most recent year available)1. Given the prevalence of obesity, hypertension, diabetes, metabolic syndrome, smoking, and poor nutrition, heart disease is not likely to decline in the near future. Not surprisingly, the use of implantable metal stents to reopen blocked coronary arteries has reached epidemic proportions (about one-million per year). Their reputation as an effective, minimally invasive, "quick-fix" for heart disease has resulted in an explosion of "boutique" surgical suites and cardiologists looking to cash in on a population of aging baby boomers falling victim to heart disease through neglect and a medical community that puts profit ahead of prevention.
But all is not well and rosy. Although metal stents are an effective short-term plumbing fix for a plugged coronary artery, they have their own long-term problems once implanted. The truth is that stent restenosis (narrowing of the stented artery) has been a constant problem. Special "drug-eluting" stents held promise as a solution but may exaggerate the problem of thrombosis (blood clots), and new research reveals that these stents inhibit the body's natural ability to generate collateral paths for blood flow.
Exactly what is a stent?
A stent is a small wire-mesh tube used to reopen and support a blocked or acutely narrowed artery. A small incision is made in the groin and a catheter (with the stent attached) is snaked up a major artery and directed to the site of the blockage using x-ray imaging. Once in place, the stent is released and expanded to force the artery open. It has become a "relatively" safe, minimally invasive procedure that can often be scheduled on an out-patient basis. Stents have been marketed (misrepresented?) so well that many consider it an acceptable price to pay for a lifetime of heart-health neglect (by both patients and doctors).
Great! So what is the problem?
What the medical community has downplayed is that stents exhibit a high rate of "restenosis." For some reason, the stented area can re-narrow at a rapid rate requiring a repeat procedure (or a full by-pass) often in less than a year. For a while, researchers thought that a new product dubbed a "drug-eluting stent" (DES) had solved the problem. These new stents have a coating that slowly releases a drug that inhibits restenosis.
Unfortunately, a new problem cropped up. Later studies revealed DES created an increased risk for heart attack due to stent thrombosis.2 The problem was severe enough for the FDA to issue an advisory that DES products should carry new warnings that the devices may increase the risk of sudden heart attack or death in patients. Accordingly, this is driving the creation of new guidelines for longer-term use of multiple anti-platelet (blood thinning) therapies such as clopidogrel (Plavix ®). The bad news is these drugs themselves carry additional risk of hemorrhage. If that were not enough, a late-breaking European study suggests that DES inhibits the ability of the body to generate collateral blood flow paths--a concerning finding that introduces some additional uncertainties.3
OK, so what is the answer?
The answer seems to be that the only good stent is no stent at all. The need for a stent is nothing more than admission of failure, the failure of the traditional medical establishment to practice and preach modern advances in heart disease prevention and reversal.
Make no mistake, a stent can save your life but it will not stop heart disease. After the first stent, the only questions are how many more you will need, how much longer you will live, and with what quality of life. Stent restenosis and thrombosis alone can mean decades of repeated procedures, risky drug therapy, and increased risk for heart attack.
Track Your Plaque has consistently advocated that consumers reject heart disease "plumbing" in favor of heart disease prevention. Our clinical experience increasingly shows heart disease can be reversed so it is never too late to start. You make the decision. Make your cardiologist rich and yourself miserable by constantly going "under the knife" and increasing your risk of heart attack or prevent and even reverse heart disease and avoid the problem altogether. Seems like a simple choice!
Get involved and stay alive!
1. American Heart Association. Heart Disease and Stroke Statistics (12-18-2007 Update).
2. Nordmann AJ, Briel M, Bucher HC. Safety of drug-eluting stents: insights from a meta-analysis. Program and Abstracts from the World Congress of Cardiology 2006, Barcelona, September 2-5, 2006.
3. Meier P, Zbinden R, Togni M, et al. Coronary collateral function long after drug-eluting stent implantation. J Am Coll Cardiol 2007; 49:15-20.
Copyright 2007, Track Your Plaque.