Conventional Treatments for Coronary Artery Disorders - Heart Disorders

Conventional Treatments for Coronary Artery Disorders

Conventional heart specialists normally treat coronary artery disorders with drugs (which affect the supply of blood to the heart muscle or the heart's demand for oxygen) or surgery. Coronary vasodilators such as nitroglycerin, for example, cause blood vessels to relax, which, in turn, causes the opening inside the vessels to enlarge. Blood flow then improves, allowing more oxygen and nutrients to reach the heart. Coronary vasodilators also reduce the amount of blood returning to the heart, thus lessening the heart's need to pump. Other drugs lower blood pressure and therefore reduce the heart's workload and need for oxygen. Drugs that slow the heart rate achieve a similar effect. All of these drugs have side effects, however, and have not proven effective in reversing coronary artery disease by removing the plaque that blocks coronary arteries.

Coronary bypass surgery, one of the most frequently recommended surgical procedures in the U.S., involves removing the diseased portions of the arteries and grafting a portion of a vein, usually taken from the patient's leg, onto the coronary arteries to replace the diseased segments, thus creating new pathways for blood flow to the heart. However, according to Ornish, heart attacks, strokes, infection, or death can occur as a result of bypass surgery, and up to one third of patients who undergo this operation suffer some form of transient or permanent neurological damage. Fifty percent of by-passed arteries clog up again within five years and 80% become blocked after seven years.

Reported in Health and Wellness , a study by the National Heart, Lung and Blood Institute showed that the five-year survival rate for patients with mild coronary artery blockage was the same whether they had coronary bypass surgery or used medication to treat symptoms. As a result of the study, the Institute concluded that as many as 25,000 bypass operations are performed unnecessarily every year.

Heart specialist Dr. Thomas Graboys reports in his Graboys Heart Letter Special Report that he and his colleagues at the Lown Cardiovascular Center in Boston conducted a study whereby they consulted with 168 patients seeking second opinions about undergoing coronary bypass surgery. They advised 83% of these patients not to have the operation. After four years, the death rate for those patients who declined the procedure was actually lower than the death rate for those who chose bypass surgery. In other words, 135 people in the study would have needlessly undergone an expensive and invasive procedure had they not sought a second opinion.

Balloon angioplasty, first employed by a Swiss cardiologist in 1977, is a relatively quick procedure that is less traumatic and expensive than bypass surgery, and is now used to treat hundreds of thousands of patients each year. In this procedure, a catheter with a deflated balloon on the end is threaded through an artery in the groin up into the patient's narrowed coronary artery. After the balloon is inflated to widen the artery, both the catheter and the balloon are removed. This compresses the plaque against the arterial walls (but does not remove it), and enlarges the inner diameter of the blood vessel so that blood can flow more easily to the heart. A newer form of angioplasty inserts a laser catheter and places it at the beginning of the blockage. The laser is activated and moved forward as it destroys fatty deposits and, after the artery is cleared, the laser catheter is removed. According to Ornish, one third of all patients that undergo balloon angioplasty find the same artery becoming narrowed or blocked within four to six months to the point that another angioplasty is recommended. Despite this percentage, balloon angioplasty accounts for 90–95% of all angioplasty operations.

As serious as a heart attack can be, about 90% of patients who reach the hospital with a heart attack go home alive, and about 95% of those people live for at least a year. This survival rate is partly the result of new treatment strategies developed over the past three decades, including the use of aspirin and beta-blocking drugs (propranolol and atenolol, for example), to control the symptoms and reduce adverse outcomes of coronary artery disease. One of the most dramatic developments, according to the April 1994 issue of the Harvard Heart Letter, has been the use of thrombolytic agents or clot busting drugs that stop heart attacks in progress and thereby limit the amount of heart muscle damaged.

In a recent clinical trial called GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator [t-PA] for Occluded Coronary Arteries), reported in the April 1994 Harvard Heart Letter , more than 40,000 patients in 15 countries were treated with either streptokinase or t-PA, the two most popular clot busting drugs in the U.S. Both effectively dissolved the clots causing the heart attacks and kept the heart muscle alive. These medications are not always effective, however. In the GUSTO trial, 19% of patients receiving t-PA still had blocked arteries 90 minutes after treatment, as did 40% of patients receiving streptokinase. As with all medications, both drugs have been associated with some risks, particularly undesirable bleeding.