By Dr. Mercola
More than half a million Americans received an angioplasty in 2007 (the most recent year for which data is available).i
This invasive procedure involves inflating a thin balloon in a narrowed artery to crush deposits; a stent (a wire mesh tube) is often then left behind to keep the vessel open.
When used during a heart attack, an angioplasty can quickly open a blocked artery to lessen the damage to your heart, and when used in this way can be lifesaving.
However, oftentimes heart disease patients receive angioplasties even though they have not had a heart attack -- a decision that goes against the latest medical guidelines and the suggestion of a new study, which found people treated using other less-invasive methods fared just as well as those who also underwent angioplasty with stents.
Angioplasty Offers "No Evidence of Benefit" Compared to Less Invasive Treatment
If you have stable heart disease, research shows that your initial treatment should usually be lifestyle changes. But less than half of heart disease patients are treated using lifestyle changes prior to undergoing angioplasty. According to an analysis of eight clinical trials involving over 7,000 people, angioplasty offers no benefit compared to less invasive treatment of heart disease.
The researchers concluded:
"Initial stent implantation for stable CAD [coronary artery disease] shows no evidence of benefit compared with initial medical therapy for prevention of death, nonfatal MI, unplanned revascularization, or angina."
As an invasive surgery, angioplasty does come with its fair share of risks, however. Among them:
Blood clots (that can lead to heart attack) Heart attack Re-narrowing of your artery Coronary artery damage (including tears or ruptures that require emergency bypass surgery) Bleeding (sometimes serious enough to require a transfusion or additional surgical procedure) Kidney damage (from the dye used during the procedure) Stroke Abnormal heart rhythms Death
Because angioplasty does absolutely nothing to address the underlying causes of heart disease, you should know that restenosis, or a re-narrowing of your arteries, is common. This occurs in up to 40 percent of angioplasties without stents, but even with a stent the risk is still around 20 percent (or 10 percent for a drug-eluting stent).ii And, of course, if your artery becomes re-narrowed the surgery was all for nothing.
Along with saving yourself from the potentially life-threatening risks noted above, avoiding angioplasty will save you a hefty chunk of change. As Consumer Reports noted:
"Angioplasty is also more expensive, the authors report. They said that by following current guidelines, 76 percent of patients with stable heart disease would save approximately $9,450 each in lifetime health-care costs. Other researchers have estimated such a shift would save $6 to $8 billion a year."
Even Drugs Can Often be Avoided for Heart Disease
The alternative treatment to angioplasty noted in the study was a combination of lifestyle changes and drugs.
" … medical guidelines have for several years said that most people who have symptoms of heart problems, such as angina (chest pain on exertion), but have not had a heart attack, should be treated with lifestyle changes and drugs first. Yet less than half of patients in that situation are treated according to these guidelines before undergoing angioplasty, research suggests," Consumer Reports states.
This may come as a surprise, but many medications commonly prescribed to heart disease patients can also be avoided. This includes statin drugs, which are taken by millions of Americans. The majority of people who use statin cholesterol-lowering drugs are doing so because they believe lowering their cholesterol will prevent heart attacks and strokes. How many of these people do you think would continue to take them if they knew these very same drugs have been linked to decreased heart muscle function and increased risk of stroke, along with hundreds of other serious side effects?
Not very many, right?
Well, you may want to reconsider your use of statins, as a study in Clinical Cardiology found that heart muscle function was "significantly better" in the control group than in those taking statin drugs!iii Further, keeping your cholesterol levels higher may actually help you to prevent disease, and is not actually linked to heart disease.
For the vast majority of people, statin drugs are an unnecessary health risk you're better off avoiding -- and you definitely want to avoid the trap of taking them to lower your cholesterol. Other common heart disease medications, like high blood pressure drugs and even aspirin, do absolutely nothing to address the underlying causes of the condition.
It is rare when a drug is appropriate for treatment of a chronic condition like heart disease, but that doesn't stop pharmaceutical companies from creating more of them. Currently, researchers are working on nearly 300 new medications for heart disease and stroke … but you likely have all the tools you need for prevention and treatment at your disposal right now.
If You Have Stable Heart Disease, Lifestyle Changes Should be Your Go-To Treatment
Most chronic diseases, including cancer, heart disease, diabetes, and obesity, are largely preventable with simple lifestyle changes. Imagine the lowered death toll, not to mention costs to the economy, if more people decided to take control of their health … heart disease and cancer alone accounted for 47 percent of deaths in the United States in 2010, and there are many strategies you can implement to lower your risk of these diseases … and most of the leading causes of death in the United States.
In the case of heart disease, the healthy lifestyle strategies that follow are not only effective as prevention; they're also useful for treatment. So what does a "healthy lifestyle" entail?
- Proper Food Choices
For a comprehensive guide on which foods to eat and which to avoid, see my nutrition plan. Generally speaking, you should be looking to focus your diet on whole, unprocessed foods (vegetables, meats, raw dairy, nuts, and so forth) that come from healthy, sustainable, local sources, such as a small organic farm not far from your home.
For the best nutrition and health benefits, you will want to eat a good portion of your food raw. Personally, I aim to eat about 80-85 percent of my food raw, including raw eggs and humanely raised organic animal products that have not been raised on a CAFO (confined animal feeding operation). Fermented foods are also important, as they are excellent sources of probiotics and vitamin K2, which is important for preventing arterial plaque buildup and heart disease.
Nearly as important as knowing which foods to eat more of is knowing which foods to avoid, and topping the list is fructose. Sugar, and especially fructose, act as toxins in and of themselves, and as such drive multiple disease processes in your body.
- Comprehensive Exercise Program, including High-Intensity Exercise like Peak Fitness
Even if you're eating the healthiest diet in the world, you still need to exercise to reach the highest levels of health, and you need to be exercising effectively, which means including not only core-strengthening exercises, strength training, and stretching but also high-intensity activities into your rotation. High-intensity interval-type training like Peak Fitness boosts human growth hormone (HGH) production naturally, which is essential for optimal health, strength and vigor.
- Stress Reduction and Positive Thinking
You cannot be optimally healthy if you avoid addressing the emotional component of your health and longevity, as your emotional state plays a role in nearly every physical disease -- from heart disease and depression, to arthritis and cancer. Effective coping mechanisms are a major longevity-promoting factor in part because stress has a direct impact on inflammation, which in turn underlies many of the chronic diseases that kill people prematurely every day. The Emotional Freedom Technique (EFT), meditation, prayer, social support and exercise are all viable options that can help you maintain emotional and mental equilibrium.
- Proper Sun Exposure to Optimize Vitamin D
Vitamin D is essential for your heart and cardiovascular system. Even if you're considered generally "healthy," if you're deficient in vitamin D, your arteries are likely stiffer than they should be, and your blood pressure may run higher than recommended due to your blood vessels being unable to relax.
It's been repeatedly shown that by increasing your vitamin D levels, you can improve your cardiovascular health and lower your blood pressure. Unfortunately, the vast majority of people are severely deficient in vitamin D. In the United States, the late winter average vitamin D level is only about 15-18 ng/ml, which is considered a very serious deficiency state. Overall, it's estimated that 85 percent of Americans are deficient, and as much as 95 percent of U.S. senior citizens.
The important factor when it comes to vitamin D is your serum level, which should ideally be between 50-70 ng/ml year-round. Sun exposure is the preferred method for optimizing vitamin D levels, but a vitamin D3 supplement can be used as a last resort. Most adults need about 8,000 IU's of vitamin D a day to achieve serum levels above 40 ng/ml, which is still just below the minimum recommended serum level of 50 ng/ml.
- High Quality Animal-Based Omega-3 Fats
Omega-3 fat like that found in krill oil improves endothelial function, a major factor in promoting the growth of new blood vessels, and has beneficial effects on your heart's electrical system, preventing potentially life-threatening heart rhythm disorders.
Omega-3 deficiency may actually be a significant underlying factor in up to 96,000 premature deaths each year, including some of those from coronary heart disease and stroke. Even the FDA allows claims for omega-3 for heart disease; it is one of the few food health claims that the FDA allows -- and, yes, I view omega-3 fats not as just another supplement, but as an essential food you need to include in your diet.
How to Determine Your Heart Disease Risk...
Before deciding on an angioplasty, it's important to be able to accurately gauge your heart disease risk – and you should know that your total cholesterol level is just about worthless in determining this risk, unless it is close to 340 or higher.
Instead, one of the most important risk factors will be your HDL to cholesterol ratio.
I have seen a number of people with levels over 250 who actually were at low heart disease risk due to their HDL levels. Conversely, I have seen even more who had cholesterol levels under 200 that were at a very high risk of heart disease based on the following additional tests:
- HDL/Cholesterol ratio
- Triglyceride/HDL ratios
HDL percentage is a very potent heart disease risk factor. Just divide your HDL level by your cholesterol. That percentage should ideally be above 24 percent. Below 10 percent, it's a significant indicator of risk for heart disease. You can also do the same thing with your triglycerides and HDL ratio. That ratio should be below 2.
If you have type 2 diabetes, you're automatically at an increased risk so you can move ahead to my recommendations above. In fact, anyone can use the above recommendations because their only "side effects" are improved health! That's the beauty of it. Together, these steps can drastically lower your heart disease risk and improve heart health -- sometimes quite rapidly. If you're otherwise healthy and your heart disease is stable, only after exhausting these strategies should more invasive options, like drugs and angioplasty, be considered.