Stent benefit questioned in stable angina

For patients with stable coronary artery disease (CAD), stent placement offered no more benefit than optimal medical therapy, according to a meta–analysis by Kathleen Stergiopoulos, MD, PhD, and David Brown, MD, of Stony Brook University Medical Center in Stony Brook, N.Y reported in the journal Archives of Internal Medicine. 

Stents had no significant effect on the risk of nonfatal myocardial infarction, unplanned revascularization, or persistent angina. The current guidelines prefer initial medical treatment with aspirin, statins, angiotensin–converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs), combined with lifestyle changes. The researchers included eight trials with a total of 7,229 patients, including the landmark COURAGE trial. For a study to be included, at last half of the patients assigned to PCI had to have been given a stent; the proportions ranged from 72% to 100%. The death rate for stent implantation was 8.9% compared with 9.1% for medical therapy. The rates for nonfatal MI were also similar –– 8.9% for stents and 8.1% for medical therapy. The rate of unplanned revascularization in the stent group was 21.4%, compared with 30.7% in the medical treatment group. The rates of persistent angina were 29% for stents and 33% for medical therapy.

Up to 76% of patients with stable CAD can avoid PCI altogether if treated with optimal medical therapy.

Simply putting in a stent in a blockage does not address the underlying problem. Lifestyle changes and aggressive medical management are far more important than just putting in a stent.

Cheerful people less likely to have CAD

Positive well-being is associated with nearly a one-third reduction in heart disease in a high-risk population with a positive family history and a 13% reduction in incident heart disease in a national probability sample, Lisa R. Yanek, MPH, of the Johns Hopkins University School of Medicine reported in the American Journal of Cardiology.

In the past, negative psychological states and diagnoses such as depression and anxiety have long been found to be predictive of poor cardiovascular outcomes.

In the study positive well-being was measured using the General Well-Being Schedule (GWBS) and predicted heart disease incidence in 1,483 siblings of people who had coronary events before the age of 60. 

The researchers classified the siblings into high-, intermediate-, and low-risk strata according to the Framingham risk score and followed them for 5 to 25 years. Over a mean follow-up period of 12 years, the siblings experienced 208 coronary events, including myocardial infarction, sudden cardiac death, acute coronary syndrome, and the need for revascularization procedures.

Results showed that the 1275 siblings who did not have a coronary event had a mean GWBS score of 75.0 points versus 69.7 points for the 208 siblings who did have an event.

Looked at another way, siblings with greater baseline GWBS scores were 33% less likely to develop heart disease, independent of age, gender, race, and traditional risk factors.

Protection was strongest in siblings in the high Framingham risk score stratum: Those with higher GWBS scores were 48% less likely to develop heart disease than those with lower scores.

The researchers then repeated the study, using a sample of 5,992 people from the general population who participated in the first National Health and Nutrition Examination Survey (NHANES). In this group, those with higher GWBS scores were 13% less likely to have a coronary event than those with lower scores. (Source: MedPage Today, Dr Sanjay Gupta)