On July 19th President George W. Bush underwent a stent procedure (PCI) for a blocked artery in his heart. The condition was discovered Monday when he had his annual physical. The operation was “performed successfully”.
As I wrote before when in 2012 Rosy O’Donnell had a heart attack that was treated with a stent, it is not at all certain that either Mr. Bush or Ms. O’Donnell have received optimal treatment. It is well known that for patients with stable CAD like Mr. Bush, PCI does not offer clinical benefits over medical therapy alone:
- In an otherwise healthy, asymptomatic (no angina) 67 years old with a single blockage there is NO reason to start treatment with a a stent. Medical therapy alone probably would have been equally effective, a lot less expensive and avoid the medications necessary to prevent stent-related complications in the future or of the medications themselves.
- While stenting is of course not responsible for the process of Atherosclerosis that causes coronary artery disease, it IS reponsible for the severe local damage to the artery involved. The result is an inflammatory reaction which involves the stented area, as well as a zone up and downstream of the artery, with a 10-15% yearly failure rate per stent.
- In essence a stent produces a new disease and to prevent the built-in complications, drugs are given to suppress the inflammatory response. There are many articles (and I have reported on them many times) showing stents do not protect against future heart attacks or prolong life, as opposed to bypass surgery (CABG), which has much superior results in patients with 3-vessel CAD.
The decision about what is the best treatment is influenced by many factors, but doesn’t include the type of “reflex stenting procedure” that appears to have been used in Mr. Bush’s case.
However, now that PCI treastment has been given his cardiovascular health can be determined by the following criteria:
- Never having smoked or quitting over a year ago.
- Keeping BMI < 25 kg/m2.
- Exercising at moderate intensity: 150 minutes (or 75 minutes at vigorous intensity) each week.
- Eating a “Heart-Healthy diet”: adhering to 4 of 5 important dietary components:
· sodium intake, 1.5 g/d
· sugar-sweetened beverage intake, 36 oz weekly
· ≥ 4.5 cups of fruits and vegetables/d
· ≥ three 1 oz servings of fiber-rich whole grains/d
· ≥ two 3.5 oz servings of oily fish/week.
- Maintaining total cholesterol <200 mg/dL.
- Keeping BP at or below 120/80 mm Hg.
- Keep fasting blood glucose < 100 mg/dL.
The new onset or recurrence of angina, the absence of a gain in quality of life or of a mortality benefit and especially, the need for repeat procedures and ongoing medications are all issues that will continue to play a major role in Mr. Bush’s future and any other patient treated this way.