Medication and Lifestyle Changes Yield Similar Results to Invasive Procedures: Study
Thu, April 22, 2021

Medication and Lifestyle Changes Yield Similar Results to Invasive Procedures: Study

Taking medication and making lifestyle changes provide the same benefits as undergoing invasive surgery among people with critical but stable heart disease / Photo by: luckybusiness via 123RF

 

Taking medication and making lifestyle changes provide the same benefits as undergoing invasive surgery among people with critical but stable heart disease, according to a major international study led by researchers at the Stanford School of Medicine and New York University’s medical school.

The results of the trial are "very reassuring" for patients with the said condition but don't want to undergo surgery, said David Maron, a co-chair of the trial from Stanford. He added that their findings don't suggest these patients should have heart procedures done to them to prevent a heart attack.

However, the trial showed that stents or bypass surgery is more effective for people with coronary artery disease who also have symptoms of angina (chest pain due to restricted blood flow to the heart).

 

Medicine and Lifestyle Changes vs. Surgery

The study involved 5,179 people, who underwent stress tests to determine the state of their blood flow. They were divided into two random groups, both of which were given medicine and lifestyle changes to treat their condition but only one underwent invasive heart procedures.

They were monitored for up to seven years and were tracked for any cardiac event such as heart attack, heart-related death, cardiac arrest, or hospitalization due to worsening angina or heart failure.

A year later, seven percent of the people in the invasive group were found to experience one of those events compared to five percent of the medicine-only group. But the trends reversed after four years, Time magazine reported, showing that 13 percent of the procedure group suffered a problem compared to the 15 percent of the medicines group.

However, the trial showed that stents or bypass surgery is more effective for people with coronary artery disease who also have symptoms of angina / Photo by: ammentorp via 123RF

 

During the entire period of the study, however, the rates showed similar results regardless of the treatment given.

For reducing chest pain, the results of the study showed that undergoing a procedure is a better treatment than medicine and lifestyle change alone. Among those who reported frequent chest pains at the start of the study, 50 percent who underwent surgery were angina-free a year later while only 20 percent of those who took medicine alone gained the same benefits, Time reported.

"Based on our results, we recommend that all patients take medications proven to reduce risk of heart attack, be physically active, eat a healthy diet, and quit smoking," Maron said in a statement

 "Patients without angina will not see an improvement, but those with angina of any severity will tend to have a greater, lasting improvement in the quality of life if they have an invasive heart procedure. They should talk with their physicians to decide whether to undergo revascularization.”

Reflecting Existing Clinical Practice

For Robert Harrington, a co-researcher of the study from Stanford, their work answers "one of the central questions of cardiovascular medicine" that ask which is the better treatment for people with severe but stable heart conditions. He added that he sees "this as reducing the number of invasive procedures.

In a statement, the researchers said the study was designed “to reflect current clinical practice" where patients with critical artery blockages often undergo procedures like an angiogram (a diagnostic test that uses x-rays to take pictures of blood vessels) and revascularization (the restoration of perfusion to a body part or organ that has suffered ischemia) with a stent implant or bypass surgery.

They added that, prior to the study, there has been insufficient evidence to suggest that these procedures are better at preventing dangerous heart events compared to merely providing patients with medication.

"If you think about it, there’s an intuitiveness that if there is [a] blockage in an artery and evidence that that blockage is causing a problem, opening that blockage is going to make people feel better and live longer," Harrington said. "But there has been no evidence that this is necessarily true. That’s why we did this study."

However, they noted that the results of their study are not applicable to people with acute heart conditions such as those who suffer from a heart attack. The researchers advised people who experience these events to seek immediate and appropriate medical care.

Seeking a Difference

The researchers are looking to continue with the study and monitor the participants for five more years to see if there are any change over a longer period of time.

Maron said the follow-up is important to determine if there will be any difference in the results as there was "no survival benefit from the invasive strategy" in the seven-year period of the study.

"I think these results should change clinical practice," he added. "A lot of procedures are performed on people who have no symptoms. It’s hard to justify putting stents into patients who are stable and have no symptoms."

The study looked into heart patients who, despite a stable condition, are living with moderate to severe ischemia due to atherosclerosis (deposits of plaque in the arteries). Also known as coronary heart disease, ischemia is among the most common cardiovascular diseases.

These diseases are the top cause of death globally that claimed the lives of about 17.9 million in 2016—representing 31 percent of all global deaths, according to the World Health Organization.

The researchers are looking to continue with the study and monitor the participants for five more years to see if there are any change over a longer period of time / Photo by: dolgachov via 123RF