A Harris Poll survey conducted in early 2016 reveals that only 57 percent of Americans know that heart disease is the number one killer of men and women in the United States. According to the survey, a significant number of consumers don’t know all the treatment choices available if they are diagnosed with CAD, or coronary artery disease.
According to Dr. Alpesh Shah, an interventional cardiologist and Associate Professor at Houston Methodist Hospital in Pearland, Texas, whom I recently interviewed, “CAD affects 15 million adult Americans and many of these individuals don’t get diagnosed on time.” Early diagnosis means early treatment and that translates into saved lives or a lower risk of the disease progressing. Dr. Shah was quite emphatic pointing out that "we need to do a better job at educating people so there is early detection (of CAD) and more individuals need to know treatment options.” The Harris Poll survey also found that:
- Vast majorities of men and women know about medicines (cholesterol, anticoagulants, blood pressure) that help treat CAD.
- One out of every three people is not familiar with surgical procedures such as coronary bypass (open heart surgery), balloon angioplasty or coronary stenting.
- Only one quarter of those familiar with coronary stenting know that some stents release medicine that helps prevent future blockages.
With regard to stent knowledge the survey found that:
- Only 27 percent of men and 19 percent of women correctly noted stents can gradually release medicine into the vessel.
- Only 40 percent of men and 31 percent of women knew that stents are placed in the blood vessels outside of the heart, as opposed to in the heart itself.
Bypass surgery has been around for decades. When a patient is diagnosed with one or more blockages in the main arteries leading to the heart, angioplasty may be recommended as a first step to clear the blockages. If the blockage is hard to access, or there are multiple blockages, the next recommendation by a cardiac surgeon would be coronary artery bypass graft (CABG) surgery. It’s an invasive procedure that requires opening the patient’s chest and putting the person on the heart-lung machine while the doctor creates a new pathway for blood to circulate. This is one of the most common major surgeries performed in the U.S. each year and obviously should be performed by an experienced cardiac surgeon.
Dr. Shah, on the other hand, is an interventional cardiologist with extensive training in novel stent implants. “Stents are a newer option and advancement in the prevention and treatment of CAD blockages," "The metallic device is inserted through a groin vessel and is placed to prop open a blockage. It can stop or prevent a heart attack and is one of the best advances in heart care in the last couple of decades.” There are also stents that can release drugs (drug-coated stents) that help to keep the artery or arteries patent, again helping to prevent future cardiac events.
Dr. Shah is especially excited about Boston Scientific’s SYNERGY stent and its advanced bio-absorbable polymer-coated stent technology that can help with treating patients from both an acute and a long-term performance perspective. The SYNERGY stent has been available since early 2016. “Drug-coated stents are now a standard of care for the treatment of cardiac arterial blockages," he says. "These stents are game-changers, and in recent years the drug-coated stent has been shown to prevent “re-narrowing” of the artery in which it was placed.” Earlier generations of (metal) stents simply propped open the artery but offered no “prevention” capabilities.
Dr. Randall Roberts, Vice Chief of Staff at Glendale Memorial Hospital, Glendale, Calif., and a cardiac surgeon for more than a decade, did clarify in a discussion with me the need for bypass surgery in certain situations. “When three (coronary) vessels are involved or the left main coronary artery (feeding about two thirds of the heart) is blocked, coronary bypass surgery has better long term results with respect to survival and need for repeat procedures. Redo surgery is relatively rare, but stents can be used after surgery for any new blockages, even in the bypasses.”
Regarding the costs involved in bypass surgery versus stent, Dr. Roberts said, “I don't know exact numbers, but surgery has a higher short term cost. That is made up by avoiding the cost of repeat presentations and procedures in the future that are associated with stents. Both stents and surgery are covered by insurance when appropriately done.” When I spoke to Dr. Daniel Goodwin M.D., Cardiovascular Committee Chairman at Glendale Memorial Hospital, he suggested that, “In the end, the relationship and communication between the physician and the patient is critical for making the best decision for that individual.”
Dr. Shah's observations about women and heart disease suggest that "we have to do a better job when it comes to heart disease in women. They are underrepresented in [cardiac] testing. The American Heart Association is putting a lot of effort into raising awareness about their risk for heart disease. It’s important to recognize that more women die from heart disease than men do and more women die from heart disease than from breast cancer.”
Dr. Shah also offered a call-to-action, suggesting that the Harris Poll survey revealed the need for more consumer education so that men and women recognize symptoms of heart disease or a heart attack and seek immediate treatment. Lifestyle is certainly a cornerstone of both preventing heart disease and treating it, but consumers need to know about all treatment options. Bypass surgery versus a stent? Talk to your doctor.
(Note: Boston Scientific, the makers of the SYNERGY stent, helped to facilitate the interview with Dr. Shah. Dr. Goodwin and Dr. Roberts were interviewed by email ed to offer a balanced view on the subject.).