Angioplasty has No Benefit Over Medical Therapy in Ischemic Stable CAD

 

A new analysis is calling into question the rationale for many of the angioplasty procedures taking place today in patients with stable coronary artery disease (CAD). In a meta-analysis of more than 5000 patients, Angioplasty was no better than medical therapy in patients with documented ischemia.

Its routine in cardiology practice to advise angioplasty or revascularization if stress test is positive. Patients with ischemia have a worse prognosis than patients who don’t. Thus cardiology practice is focused on finding and treating ischemia. However, the analysis of this study suggests that this approach may not be the right one.

 

Brown and colleagues reviewed the literature for clinical trials of angioplasty and medical therapy for stable CAD conducted over the past 40 years, ultimately including five trials of 5286 patients. These were a small German trial published in 2004, plus MASS II , COURAGE , BARI 2D , and FAME 2 . In all, 4064 patients had myocardial ischemia documented by exercise, nuclear or echo stress imaging, or FFR.

Over a median follow-up of five years, mortality, nonfatal MI, unplanned revascularization, and angina were no different between patients treated medically vs those treated with Angioplasty.

The analysis suggests that it may be worthwhile to continue medical therapy in patients with minimal symptoms and not subject them to unnecessary intervention.

 

via PCI No Benefit Over Medical Therapy in Ischemic Stable CAD.

Stay happy, stay heart healthy!

Mental health has been one of the neglected areas of medicine. Whenever one visits a cardiologist, its common to get advice on weight, diet and exercise. But rarely does the physician speak on mental health and its effects on the heart.

Multiple studies have studied the relation ship between mental health and heart disease, in particular coronary artery disease.

Its been found that acute mental illness like Depression and long term stress like anxiety, work related stress, panic attacks can have a bad effect on cardiac health.

Individuals with serious mental illnesses like depression, bipolar mood disorders and schizophrenia have increased incidence of obesity, altered dietary habits and eventually increased incidence of coronary artery disease. Also long term mild problems like anxiety and work related stress cause an increase in heart disease problems.

Also patients with heart attacks who develop depression later fare badly in the long term when compared to ones without depression.

Its imperative for the Cardiologist to look for mental disorders and its symptoms in their patients to prevent and treat these disorders in the early stage.

 

Some general guidelines to improve mental health:

Walk/ exercise everyday. Exercise is a great mood elevator and stress buster. Walking half hour a day at a brisk pace can have profound effect on physical and mental health.

Eat well. Eating every 2-3 hours in small portions keep the mind satiated. One can avoid binge eating which is associated with stress and anxiety.

Meditate daily for 15 minutes. Just sitting still and breathing slowly with one concentrating on his/her breath relaxes one’s body and mind.

Be more social. Go out and make friends. Spend time with your relatives.

Always think positive. 

 

So, Stay Happy and Heart Healthy!

Drugs for Angina or cardiac pain!

Angina pectoris, which is more commonly known as angina, is severe chest pain caused by a lack of blood (ischemia) in the heart muscle.

The commonest cause of angina is blocks in the coronary arteries which cause obstruction to the blood flow.

The common drugs which are used to treat angina are as follow:

1. Beta-Blockers: This is a class of drug which reduces the heart rate. Thereby, they reduce the oxygen requirement of the heart. This causes relief in angina. 

The drugs approved for this condition are Metoprolol,  Bisoprolol, Atenolol, Nebivolol and Carvedilol. These drugs are started in normal doses and then increased till the time patient is free of his symptoms. Majority of the patients tolerate them well. They need to be monitored for the side effects like bronchospasm and slow heart rate. 

If a patient is unable to tolerate the beta-blockers, the alternative group of drug which can be prescribed is called Calcium channel blockers. Some of the drugs used are Diltiazem and Verapamil. They can be used in patients with lung problems as they have no effects on lung function unlike beta-blockers.

2. Aspirin: the commonest drug prescribed to all cardiac patients. This is an anti-platelet drug and thus prevents clot formation in the arteries. It is given in a dose of 75-150 mg a day. It should be consumed after food to avoid gastric irritation.

3. Statins: These are drugs which reduce cholesterol and triglyceride levels. The prevent the formation of plaques or blocks in the coronary arteries. They also reduce the incidence of heart attacks in the patients. The common ones used are Atrovastatin, Rosuvastatin, Simvastatin etc. They are to be taken after dinner for maximum effect.

4. Nitrates: There are drugs which cause dilatation of the coronary arteries and are very helpful in relieving angina. They can be taken by keeping the tablet below the tongue (Tab Sorbitrate) or consumed with glass of water. They are also available as oral sprays or skin patches. They can cause headache or giddiness as their side-effect.

Most of the patients with angina can be easily controlled with drugs and can be symptom-free (pain free). The non-medical options are angioplasty or bypass surgery which can be reserved for patients with intractable symptoms.