Overuse of angioplasty — which uses balloon-equipped catheters to open narrowed arteries — made national headlines this past year, with the Department of Justice and the Senate Finance Committee investigating incidents in which hospitals subjected hundreds of patients to needless procedures.
Recent research suggests that the problem is not isolated to a few overzealous practitioners. Only half of procedures that used angioplasty in non-emergency situations were clearly appropriate, according to a study of almost 500,000 cases published in July in the Journal of the American Medical Association. The researchers also uncovered wide variation among hospitals; the rate of clearly inappropriate procedures varied from less than 6 percent at some to greater than 16 percent at others.
One factor leading to the overuse of angioplasty is that the same doctors who perform the procedure often also act as gatekeepers for the patient’s cardiac care. For example, patients often sign a consent form for angioplasty before going in for angiography, the definitive test for blocked arteries. Then, if the angiogram reveals blockages, the interventional cardiologist can recommend clearing them while the patient is still on the table. Convenient? Sure. But necessary? Usually not.
Most patients and doctors overestimate the benefits of the procedures, suggests a 2010 survey of 153 patients and their physicians at a Massachusetts medical center. Just 63 percent of physicians knew that except in emergencies, angioplasties only ease symptoms. And even those who were up-to-date apparently often didn’t inform their patients: 88 percent of patients who consented to the procedure mistakenly believed it would reduce their risk of having a heart attack.
Many people fail to take the proven steps to prevent heart attacks and strokes. The strategies listed below are ranked by the number of heart attacks and strokes they could prevent in American adults over the next 30 years, according to a 2008 report in the journal Circulation.
●Problems prevented: 6.2 million heart attacks, 7 million strokes.
●What you can do: Get your blood pressure checked at least once a year. If it’s high, cut back on salt, lose excess weight and exercise more.
●Goal: An LDL (bad) cholesterol under 160 for people at low risk of heart attack, 130 for those at intermediate risk, and 100 for those at high risk.
●Problems prevented: 9.6 million heart attacks, 3 million strokes.
●What you can do: Men 35 and older as well as women 45 and older with coronary risk factors, such as high blood pressure, should get tested at least every five years. Other adults might consider testing, too. If your levels are high, control your weight, exercise more, quit smoking and eat a heart-healthy diet.
●Goal: A body mass index (BMI) under 30 (the cutoff for obesity) and preferably under 25 (the cutoff for being overweight).
●Problems prevented: 7.1 million heart attacks, 1.1 million strokes.
●What you can do: Determine your BMI by multiplying your weight in pounds by 703, then dividing by your height squared in inches. Even simpler: Measure your weight. Men with a waistline over 40 inches and women with a measurement over 35 inches should lose weight.
●Goal: A fasting blood glucose level under 110 for people who do not have diabetes, and preferably under 100; an A1C level (a measure of long-term blood sugar control) under 7 percent for people who already have the condition.
●Problems prevented: 4.8 million heart attacks, 600,000 strokes.
●What you can do: Consider getting your blood sugar level measured, especially if you’re at high risk for Type 2 diabetes because of high blood pressure or cholesterol levels or excess weight. The same lifestyle changes that lower blood pressure and cholesterol can lower blood sugar, too.
●Goal: Quit — for good.
●Problems prevented: 3.3 million heart attacks, 1.4 million strokes.
●What you can do: Talk with a doctor about the best smoking-cessation program for you and get yourself examined for smoking-related illness.
●Goal: Take a low-dose (81 milligram) aspirin daily if appropriate.
●Problems prevented: 3.4 million heart attacks, 300,000 strokes.
●What you can do: Starting at age 45 for men and 55 for women, talk to a doctor about your risk of heart attack, stroke and gastrointestinal bleeding.