Angioplasty, Stents, and Statins

My husband and I attended a webinar entitled How Effective Are Statins and Stents last Wednesday, courtesy of Dr. Michael Greger of Although neither of us has a heart condition to warrant treatment, Dr. Greger’s well-researched videos always get my attention. Moreover, since heart disease is the number one killer in America, it never hurts to know something about it.

Statins purport to reduce the risk of myocardial infarction (MI, a.k.a. heart attack) and death among those with coronary heart disease by reducing low-density lipoprotein (LDL) carriers of cholesterol. According to the Journal of the American Medical Association, 27.8% of adults over 40 in the United States use statins.1 Not surprisingly, Pfizer’s Lipitor holds the record for the best-selling drug in the history of the pharmaceutical industry. Even with an expired patent, Lipitor still rakes in nearly $2 billion in annual revenue.2

Stents are tiny mesh tubes that surgeons use to prop open blocked arteries or ducts and restore the normal flow of fluids. Angioplasty provides a minimally invasive alternative to stents by using tiny inflatable balloons to compact spongy debris (plaque) in narrowed vessels. Hundreds of thousands of Americans avail themselves of these procedures annually, and they’re neither cheap nor risk-free. According to Dr. Greger, 1 in 150 cases result in death from the stents, 2% experience blood vessel damage, and 3% react negatively to the blood thinners that complement the procedure.

Dr. Greger addressed the surgical procedures first – i.e., angioplasty and stents. He began by noting the benefits of these treatments for patients in emergency situations. If a blocked artery threatens death or disability, then taking immediate remedial action makes sense. But what about elective procedures for those with stable coronary artery disease? Do they prevent heart attacks and/or prolong life?

Using double-blind, randomized control trials involving thousands of patients, medical researchers identified no material benefit in mortality or infarction rates using angioplasty or stents for non-emergency circumstances.3 It turns out that most heart attacks are caused by nonobstructive blockages. These small lesions span the entire vascular system and can “pop” at any time. Treatment for a small sample of trouble spots does not constitute a cure nor provide material long term protection.

Dr. Greger claims that cardiologists have known all about the trials that have cast doubt on the efficacy of angioplasty and stents for treatment of stable heart disease; 70% admit to performing the procedures because they profit from them. The overwhelming majority of patients continue to believe that they benefit from them, yet only 3% have been shown to have been given all of the facts before they agreed to move forward.

Statins offer the promise of reducing the risk of heart disease by lowering plaque-inducing LDL cholesterol. As noted above, they’re widely prescribed, and patients are told that they’ll reduce their relative risk of heart attack by 50%. In absolute numbers, a person on statins has a 2% chance of a heart attack versus a 3% chance without medication. For that 1% drop in risk there’s a compensatory increase in risk of contracting diabetes that persists years after discontinuing treatment.

Here’s the good news: Nothing comes close to reducing one’s risk of heart disease and diabetes than making healthy lifestyle choices. That means pursing a predominantly whole foods plant based diet, eliminating proceeded foods and sugar, losing excess body fat, exercising (aerobic, weight-bearing, stretching), quitting smoking, minimizing stress, and getting a good night’s sleep consistently.

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    3. The 2007 Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial revealed that percutaneous coronary intervention (PCI) did not reduce death, myocardial infarction, or other major cardiovascular events compared with optimal medical therapy alone. The 2017 Objective Randomized Blinded Investigation with optimal medical Therapy of Angioplasty (ORBITA) trial revealed that PCI did not relieve symptoms of coronary artery disease. Those who participated in “sham surgeries” experienced the same symptom relief as those who had PCI.