Angioplasties, Drug Therapies and Loving Your Heart
April 4, 2008
Clinical trials such as OAT and COURAGE published a few years back seem to provide contradictory results to the general consensus at the time of publication that angioplasties provide better survival rates long term. OAT, which looked at 2166 patients who did not have the opportunity to receive an angioplasty quickly enough to avoid damage to the heart were randomized to get an angioplasty or e drug therapy. Four years after implementation of therapy 17% of the patients in the angioplasty group died as compared to 15% in the drug therapy group. It must be noted that the patients in the drug treated group were optimally treated on the best available meds at that time. Following OAT, the COURAGE trial was released. The trial looked at 2237 patients with chronic stable chest pain or angina. The study found that the rates of heart attacks and death were 19% in the angioplasty group as compared to 18.5% in the drug treated group. To say the least, the results of these two trials did not go well among cardiologists that were proponents of angioplasty/stent based therapies as compared to those that believed in conventional therapies methods.
Now the reason why I am writing this blog is because cardiovascular disease is the number killer in the United States and diabetes according to the National Cholesterol Education Program Adult Treatment Panel III, is a coronary heart disease RISK EQUIVALENT. What does this mean; it means that if you have diabetes it is equivalent to the risk factors for heart disease which include a positive family history, smoking, high Low Density Lipoprotein and age (men >45 and women >55 years of age.}
In the Caribbean community diabetes is a prevalent disorder and often times it goes untreated because it does not get diagnosed until organ damage occurs and the symptoms are physically felt or the disease itself is not taken seriously as to potential damages that can occur if not optimally treated like eye, kidney and feet damage.
So here is the scenario…you go to the doctor one day to get a check up because you are simply just not feeling well. What you are feeling is laziness, you are urinating a lot and you are getting thirty quite often among the fact that you cannot get an erection (speaking of a male of course). So he do a finger stick to test your sugar and blood pressure and he/she comes back and tells you that you have diabetes and hypertension and you probable had it starting a few years back. But you say “I was fine all along. How could this happen to me? Impossible!” Well it very well can happen dear friend…hypertension is known as the silent killer. The symptoms are not felt until quite some time has elapsed when the heart and kidney among other organs cannot compensate for the sheer force of the blood in the arterial walls…it is then when the symptoms can occur. In diabetes it’s the very similar thing. The pancreas which is essential for the production of insulin malfunctions, causing insulin deficiency because insulin is the key transporter of glucose to the muscle cells to be stored for future energy needs. So when you eat a high carbohydrate meal…like rice the sugars broken down from the complex carbohydrates never gets utilized by the muscles and thus are left roaming in the blood stream and this is not a good thing for many many reasons.
So the doctor prescribes diet and exercise and an oral anti-hyperglycemic and a antihypertensive to treat the high blood sugar and high blood pressure. Guess what! He will take your blood and send it to the lab to do a lipid profile because more than likely you have high levels of bad cholesterol and low levels of good cholesterol. This is quite often the case in the Caribbean community because of the foods we enjoy that are high is saturated fats like black pudding, ox tail, fried rice and fried chicken, goat curry, duck curry etc. but we cannot stop eating them and that’s just the plain reality…what we can do however is eat them in moderation. But how many of us truthfully do that? I leave that question open-ended. We all know who we are and I will be the first to say that I am guilty.
So the lab results come back and your physician tells you that you have high cholesterol and give you a pill. What he means is that your low density lipoprotein is high for the most part….this is a particle that is in the blood stream that is present all time and causes injury to the interior lining of you arteries if present in high amounts. It cause damage in your artery by latching itself on the injured location and starts accumulating as times goes on. But by having high cholesterol, your Dr will more than likely prescribe a one in a class of drugs called statins to reduce your Low Density Lipoprotein (LDL).
So now a couple of years go by…you are compliant as to taking your medicines in the way recommended by you Dr and you are on a maximally strict diet. But one day upon walking up the stairs or doing some yard work you start to feel some chest pain but you pass it off as simply exertion and rest is what you need. In fact, after you rested for some while it goes away but again the next time you do some yard work you begin to feel exhausted quickly to the extent that you were not normally used to and again you feel the persistent pain in the chest that goes away after you had some rest, Chances are you might have a something called Angina. Angina can manifest itself in two forms (stable and unstable), the stable manifestation is what I discussed above. The unstable form differs from the stable because it can occur when you are resting.
So you now go to your doctor and he places you on an antiplatlet therapy so that your blood has a lesser chance of clothing and sends you to a hospital that has caterization lab to do an angiography which is a test conducted to find out where and how many blockages you many have in your arteries which are what might be contributing to your exhaustion and chest pain. It should be noted that angioplasties is just one in a few tests available to detect an occluded vessel The results come back and you have 2 blockages in your coronary or left descending arteries of your heart. The recommendation of your doctor is to have stents placed because the plaque build up form the LDL deposits occluded the artery to a significant extent that in order for you to breath better and have no chest pain is to have drug coated stents or bare metal stents strategically placed where the occlusion is in order to keep the artery open.
Well up to a year and a half ago inserting stents in these occluded areas were though of as the gold standard for such as disease state as described above, however, the two studies OAT and COURAGE questions this procedure as to the outcome it provides when comparing to drug therapy. The data from the two studies seem to point into the direction that both therapies are similarly effective in reducing a hard endpoint such as death.
So what are the options now? The option is to stay healthy as much as possible. Reduce all saturated fats and foods high in cholesterol. Become educated—understand the diseases that affect you. Cooking with olive oil is a healthy way to go. Eat in small portions. Do not eat a heavy meal after 9 pm. Get regular check ups by your physician. It is important to formulate a professional patient/doctor relationship so a single physician becomes familiar with your history and life style habits. If you smoke, just quit. Cutting smoking will be the best thing you can do for your body and try to walk at least for half of an hour 3 to 4 times per week.
These tips, I am sure many of you are already aware of but it helps to get reminded ever so often. Moreover, in addition to the reasons attested to before, this article was written create awareness in what can happen if you do not become proactive with your health.
Andrew
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[...] http://baiganchoka.com/blog/2008/04/04/angioplasties-drug-therapies-and-loving-your-heart/The pancreas which is essential for the production of insulin malfunctions, causing insulin deficiency because insulin is the key transporter of glucose to the muscle cells to be stored for future energy needs. … [...]