Was President Bush's Stent Surgery Necessary? (Op-Ed)

LiveScience.com

Dr. Steven Lamm is director of the New York University Center for Men's Health and a clinical assistant professor in the department of medicine at New York University School of Medicine. A practicing physician, researcher and author of six books, he contributed this article to LiveScience's Expert Voices: Op-Ed & Insights.

The current issue of the British Medical Journal questions the benefit of the procedure former president George W. Bush received earlier this year to open a partially-blocked artery. It raises the question of how physicians assess the specific needs of each patient in relation to the different approaches to detect and treat heart disease.

Experts wondered whether Bush's treatment was overly aggressive because news reports suggested that he hadn't had any symptoms of heart disease. The journal piece, by Dr. Aseem Malhortra, a cardiologist at the Royal Free Hospital in London, said cardiac stents are a prime example of unnecessary, costly medical interventions. "Even stenting a 90-percent stenosed [narrowed] artery for stable angina does not prevent heart attacks or prolong life," he wrote.

The article is part of the British Medical Journal's "Too Much Medicine" campaign designed to get out the message about causes of unnecessary care.

Heart disease is the America's number one killer, and it's a formidable foe. Because it is so dangerous, unpredictable and sometimes devastating, both physicians and patients treat risk factors and symptoms very seriously. Yet, out of about 360,000 sudden cardiac deaths that occurred last year in the United States, more than half of the patients had no symptoms or identified risk factors.[Heart Disease: Why Positive Attitude May Bring Longer Life ]

Because coronary heart disease is so complex, deciding when and how to treat a particular patient with a given set of symptoms can be challenging. Physicians can't have a "one size fits all" strategy.

Both patients and physicians are naturally afraid that failure to treat a narrowed artery could have a devastating effect. Together, the doctor and the patient have to weigh all the pros and cons of treatment. I'm certain President Bush had a role in deciding, among several alternatives, what he was most comfortable having done.

But the debate about stenting needs to go farther. As physicians focus on prevention, we have to realize that even if a patient does all the right things — not smoke, manage cholesterol, get exercise, reduce stress and maintain a healthy weight — there is still a 40 to 50 percent chance he or she will develop heart disease.

That's right: even when you do everything you can, it doesn't mean you will be immune from having a serious cardiac event.

But doctors are beginning to find new ways to assess patients' actual, physiological risks for cardiac disease early on, and are witnessing the evolution of new technologies that will identify how aspects of a cardiovascular system are actually functioning, in real time.

One example of such a new technology is a test called EndoPat, and it feels a lot like just getting blood pressure checked. The test takes about 15 minutes and measures what is called "reactive hyperemia": arterial health, or the ability of the lining of blood vessels to react to a body's needs. The test goes beyond looking at typical signs of heart health, such as cholesterol, to actually analyze function.

For some people, technology like EndoPat, made by Itamar Medical, will bring good news that their vascular health is terrific. Others may learn that their cardiovascular system has some functional issues, and may be motivated to take their prevention plan to the next level, perhaps ramping up their exercise or modifying their diet. Someone with an A-plus heart-healthy lifestyle and no known heart disease risk factors who shows signs of disease may need a closer look at why his or her blood vessels are suggesting problems.

These new function-oriented tests may make the more invasive, after-the-fact treatments like stents obsolete. Discovering a patient's actual cardiovascular situation early in the game — when prevention can have maximum impact — could make a huge difference in the fight against heart disease.

Be sure to talk with your physician about your own philosophy about the healthcare decisions you must make. Are you more of an interventionist, likely to be willing to have procedures and treatments, even when there are risks to be weighed? Or, are you more likely to want less-invasive tests and treatments?

And remember: no exercise, food, drug, lifestyle or test, for that matter, will guarantee you good health. But learning whether your prevention efforts are working — and how well — can help you understand your actual risk for coronary artery disease. With that direct feedback, your efforts at prevention can be personalized and fine-tuned to help ensure they are effective as possible. One size does not fit all.

The views expressed are those of the author and do not necessarily reflect the views of the publisher. This version of the article was originally published on LiveScience.

Copyright 2013 LiveScience, a TechMediaNetwork company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
View Comments (11)