Medicines-Only Treatment OK for Many With Heart Disease
New research offers good news for many people with reduced blood flow to the heart, two Einstein Healthcare Network cardiologists say.
The study, and a companion “quality of life” study, found the following:
- People with stable symptoms (those that are not getting worse) can be treated safely for the condition known as ischemic heart disease with medicines alone.
- Those whose symptoms include chest pain (angina) may feel better if they receive a stent or surgery to unblock arteries, rather than take medicines alone.
No Procedure, No Increased Risk
“Until now there was always the concern that if these patients aren’t treated with a stent or surgery, there’s a significant risk of a heart attack and death,” says Olayinka Afolabi-Brown, MD, a cardiologist at Einstein Medical Center Philadelphia. “This trial showed that was not necessarily the case.”
With or without interventions such as a stent, “there was no significant difference in outcomes such as heart attack and death in patients with stable ischemic heart disease,” he says.
Sahil Banka, MD, a cardiologist who performs procedures such as stent placement, agreed that the results are important.
“This study has given us more information about patients with stable ischemic heart disease and found out that they’re actually fairly safe to try to be on medicines to control their symptoms,” Dr. Banka says. “And if they feel good with medicines, it’s okay to keep them on that.”
Results of the study, known as ISCHEMIA, were presented in November at an American Heart Association meeting in Philadelphia.
Results for Stable Heart Disease
Ischemic heart disease is a common condition caused by blockages in arteries that reduce blood flow to the heart. The study focused on people with stable disease. Their symptoms were steady, not getting worse.
The 5,000 participants were randomly divided into two groups. One group was treated with medicines only. In the other group, most people also had a procedure, such as insertion of a stent or bypass surgery, to open up the blocked arteries.
After about four years, both groups had similar rates of death, heart attack or other events related to their disease.
“Those who got the stents had more heart attacks initially related to the procedure, but they prevented the heart attacks long-term,” Dr. Afolabi-Brown says.
“The medicines-only group had more events in later years, so the average was the same for both groups.”
Some Still Got a Procedure
However, Dr. Banka said that heart attacks occurring during a procedure are often smaller, less dangerous and more easily treated (with a stent) than those that occur later.
About one-quarter of the medicines-only group still ended up receiving a stent or surgery at some point during the four-year study.
“They were not happy with the amount of chest pain they were still having, or symptoms they were having despite the medicines, or they couldn’t take the medicines,” Dr. Banka says.
The research results were not surprising – they confirmed those of an older study that some had said was out of date. But both doctors said they think the new study will change medical practice somewhat.
Changes in Medical Practice
“I think procedures will be reduced or at least delayed in many patients, and they can try medical therapies safely as long as they are the right type of patients that this study refers to,” Dr. Banka says.
“The changes would be more of a discussion with the patient and just more information to provide the patient,” says Dr. Afolabi-Brown.
“The other thing that it showed was in terms of actually improving angina, the stents were definitely better,” he says. “So I’m able to let them know that if you get the stents, it might not necessarily make you live longer, but it’ll make you feel better.”
Both cardiologists also pointed out that the study results don’t apply to everyone with ischemic heart disease – coronary artery disease that causes blockages to arteries that feed the heart.
People in the study had moderate to severe disease, as shown by stress tests or other tests. They were then evaluated for certain blockages with a CT scan.
High-Risk Groups Excluded
Some high-risk groups were not allowed to participate in the study, so results would not apply to these groups. They included people with:
- Unstable heart disease, such as having a heart attack or symptoms that are getting worse
- Certain high-risk blockages in major arteries
- Severe angina despite treatment with medicines
- Some types of heart failure
“I think it’s important that people know they have options, that one treatment is not best for everyone,” Dr. Banka says. “They should understand that their expectations are also part of it and if they choose one treatment or the other, it’s not necessarily wrong.”
Dr. Afolabi-Brown agrees. “It’s going to vary from patient to patient,” he says. “Some patients are very averse to procedures. And I think this is reassuring for them that taking medicines is just as good and it’s safe. And some people just want like a one-and-done to fix it.”
Find out more about heart and vascular care at Einstein.