The patients selected for the study were patients with severe but stable heart disease. The common practice is to treat these patients with either heart bypass, angioplasty or stents. The study is designed to answer the question - Is there additional benefits of treating these patients with stents if they are already receiving optimal medical therapy?
The answer was - No. There were no additional benefits of using stents in stable patients.
Why was there no additional benefits? Stents do not prevent the rupture of unstable cholesterol plaques - the cause of most heart attack. Aggressive cholesterol does prevent plaque rupture.
Another compelling reason for more aggressive preventive medical therapy and less aggressive stent therapy is this - only 14% of heart attacks involve an artery with more than 70% obstruction.
The vast majority - 68%, involve the rupture of a cholesterol plaque in an artery causing only mild and insignificant obstruction. Optimal cholesterol treatment benefits all the plaques in all arteries; stents does not. Cholesterol treatment prevents plaque rupture and the ensuing heart attack, stroke, coronary death, etc. that follow.
There were 1,000,000 stents deployed in 2004 at a cost of billions of healthcare dollars. What percent is really necessary?
Cardiologists, cardiology fellows, policy makers, insurance companies and the public need to be more educated about prevention. Prevention is an option that is supported by a large volume of scientific data. Not only is it cost effective but, in the vast majority of cases, the better option.
