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Coronary bypass operations, reaming out arteries with balloon-tipped catheters, and placing drug-coated wire-mesh tubes in blood vessels to keep them open are procedures performed on millions of Americans a year.
But most of these expensive and sometimes risky operations may actually be unnecessary, according to Miami cardiologist Michael Ozner, medical director of the Cardiovascular Prevention Institute of South Florida, because they skip counseling patients about diet, exercise and stress management. Ozner is one of many doctors who are vocally critical of what they see as the overuse of "interventional cardiology," which is lucrative for the physicians and hospitals that perform it, but which may actually be frivolously wasting the country's limited health-care resources.
While some patients are clearly benefited by these invasive interventions, even to the extent of saving their lives, such people tend to be only the gravely ill. Most patients who are referred for bypass operations (in which part of a blood vessel from the leg is removed and then sewn into a coronary artery to bypass a clog), angioplasties (the balloon-tipped catheter procedure) or placement of stents (the tiny wire-mesh tubes) are healthy people who display no cardiac symptoms.
They may simply have been flagged by one or more cardiovascular tests as having a seriously narrowed coronary artery. However, studies have failed to show that these three invasive procedures in symptom-free patients can reduce the risk of heart attacks, crippling angina (heart pain) or sudden cardiac death. "We've extended the indications for surgical angioplasty and stent placement," Ozner said, "without any data to support the procedures in the vast majority of patients - stable patients with blockages in their arteries."
The research done to date, actually shows, Ozner continued, that placing stents in these patients fails to protect them any more than reducing cardiac risk by living a heart-healthy lifestyle, taking medication and, if warranted, adding nutritional supplements. The research also indicates that stents can occasionally be a net negative by increasing the chance that a dangerous clot will form in a heart artery, as noted in 2006 by a Food and Drug Administration advisory panel.
And, in one study on balloon angioplasty, published in 2003 in the Journal of the American College of Cardiology, it was found that the catheter procedure actually increased the risk of a heart attack or death. The three invasive treatments cost about $60 billion a year in the United States. Although they've been proven not to prevent heart attacks or coronary mortality in most patients, they're covered by insurance, while the far less expensive counseling about
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