Stent or meds?

I had a angiogram yesterday and they found a blocked artery (80%+). I’m now on statin (Simvaststin 40mg) and Beta blocker (Bisoprolol 2.5 mg). Been on Ramipril (10mg) since Jan. Doc says to try this for 3 months and see if I still get angina. If not, could stay on the meds - or he said a stent. If I went for a stent in the end, do you still need to take meds? I feel a stent would make me feel ‘safer’ ? Any ideas / help? Thanks

[Milkfairy Heart Star]

Hi 123molly

You would still need to take tablets following a stent insertion.

Including an antiplatet medication for a year and aspirin for life.

The results of a really big study was published last comparing the treatment of stents and medication for angina . It showed that stents are no more protective than medication.

You can help yourself by making life style measures to manage your heart disease .

No smoking

Exercise

Keeping your weight down

Managing your stress

Adopting a diet such as the Mediterranean diet & reduce your intake of processed foods

Sleep is important too.

We can't dodge our genes or pollution which can also have an effect.

Perhaps keep a diary of angina episodes to see if the medication makes a difference and take this back with you when you see your Cardiologist to discuss what the best treatment is going to be for you.

medscape.com/viewarticle/92...

[Hidden in reply to Milkfairy]

That’s helpful Milkfairy, thanks. This has come as a shock as, whilst not exactly athletic, I’m fit for my age (71) - swimming, walking, etc. I’ve been vegetarian all my adult life, never smoked. I used to drink a glass of wine each night - cut that out since Christmas! Doc yesterday said it’s genetic, but the good diet / lifestyle had helped delay it. Yes, I will keep a note of angina. My thinking was that a stent would stop me thinking about the blocked artery getting totally blocked.....

[Chappychap in reply to Hidden]

" Doc yesterday said it’s genetic, but the good diet / lifestyle had helped delay it."

I sometimes think that the "it's genetic" explanation is overused. Yes, of course your genes are an important factor in the heart disease equation, but unlike some other diseases, like say Huntington's Disease or Hemophillia, which are overwhelmingly inherited, with heart disease your DNA is usually only one small part of the story.

I suspect that when a doctor says "it's genetic" to a heart patient, what they're really saying is that it's all too complicated to explain in a ten minute consultation!

For most people with heart disease the standard NHS life style advice makes perfect sense. For example I had no family history of heart problems (and furthermore I had some private DNA tests that confirmed there was no real genetic explanation for my atherosclerosis), but I was overweight, didn't exercise, had a stressful job that required lots of long haul flights, endless jet lag, lots of dining out and late night meetings. Once I fixed all those then my risk markers quickly fell back into the safe zone.

And for the vast majority of atherosclerosis sufferers on this forum the standard NHS line is pretty much the optimum treatment. Most of us have only ourselves to blame, so fixing our bad behaviour will massively extend our life expectancy.

But there are a small group, and perhaps you're amongst them, who were living exemplary life styles before their diagnosis. For these people the NHS advice pretty much amounts to "keep doing what you did before and let's hope the medication makes the difference". If I were in that group I wouldn't find that particularly reassuring, especially as the standard heart disease medication doesn't have an outstanding track record of materially enhancing mortality expectations.

If you think you are in that group then I'd recommend reading a book by Doctor B. Bale called "Beat The Heart Attack Gene", besides giving a lot of interesting background information on the true nature of atherosclerosis, it also goes into detail that in a minority of cases heart disease can have some pretty bizarre explanations. For example gum disease might be the real cause, or sleep apnea, or exposure to heavy metals. Or any one of hundreds of other factors.

Alternatively it could be that you're not being totally honest in your assessment of your previous life style? Maybe it wasn't quite as healthy as you're assuming?

Let me illustrate with an example. Soon after my daughter had gone up to university she announced she'd turned Vegan. Well, there's plenty worse news to receive from a teenage daughter, so I didn't think anything more of it. But later when I visited her I saw that her version of Veganism chiefly featured eating breakfast cereals direct from the box!

All I'm saying is that you need to ruthlessly assess your previous vegetarian diet. If it was whole food based then okay (although be aware that the NHS and the BHF both recommend a Mediterranean diet rather than a vegetarian diet). But if it was full of highly processed packaged foods, or starchy or sugary foods, then it's a version of vegetarianism that offers scant protection against atherosclerosis.

Sorry for the long winded answer, good luck for the future!

[SpiritoftheFloyd in reply to Chappychap]

"Most of us have only ourselves to blame, so fixing our bad behaviour will massively extend our life expectancy." - Yes I completely agree. I hold my hands up to that one - smoked, poor diet, overweight, stressful job and not active enough.

I think that for those of us who fall into this category, the first and most important hurdle we have get over is to look in the mirror and say that the HA wasn't down to bad luck, or adopt the Why me attitude, but to accept that we're here because of our poor lifestyle choices.

A friend of mine had prostrate cancer a few years ago (now thankfully clear), that, like the majority of cancers, probably isn't down to lifestyle, and all you can do is go for the radiation therapy, and wait for the next test for the PSA level to drop. I think just having to wait would be some sort of hell.

Once I'd got over the shock of it, and having read up on the lifestyle issues, I found having the ability to have an input into it really gave me something to focus on and gave me a series of objectives to aim for to hopefully improve my chances of being here for quite a while. It certainly helped day by day, things like not smoked for 30 days, 40 days etc made me feel like I was actively doing something to improve my health.

[Hidden in reply to Chappychap]

Lots to think about there, Chappychap - thanks for taking the time to reply. I certainly wouldn’t have described my diet as “exemplary”, and there are obviously improvements to be made, but it would be considered pretty healthy by most people. However, I was using a fair bit of salt, and some salty foods / feta cheese, olives, etc and probably drinking bit more than I should. Fair cop!

[MichaelJH Heart Star in reply to Hidden]

👮

[84green in reply to Milkfairy]

Thanks Milkfairy.

That’s an interesting survey. When I was diagnosed with minimal and mild atherosclerosis in some arteries in January, the cardiologist referred to a recent survey that found medication/ lifestyle changes to be as effective as surgery as a treatment. I guess this is the survey he was referring to. Due to everything going on at the time, I was only taking in the headlines!

His view being that medication/lifestyle changes could stabilise the condition and either avoid the need for surgery or at least delay it significantly in patients where the risk factors and symptoms (or lack of) justified this approach.

Clearly stents and CABGs remain vital and life saving treatments when needed but the suggestion here seems to be that stents in particularly are sometimes used unnecessarily.

[SpiritoftheFloyd in reply to Milkfairy]

Thank you for posting that Milkfairy, an interesting read.

The last sentence by Dr Hochman again reinforces what has been said many times over;- "The major challenge in medicine is to get people to comply with their medicines and change lifestyles to reduce risk factors."

[MichaelJH Heart Star]

A stent may relieve symptoms from that specific artery. Did they find stenosis in any other arteries. The medication and lifestyle changes are for life to try and arrest any progression of CVD. Keep us updated.

[Hidden in reply to MichaelJH]

Stenosis is ? - more build up in the other arteries? I felt they were saying of the 3 arteries discussed, 2 were ok, and were compensating for the blocked one. Seeing nurse at GP surgery tomorrow - I’ll see what info she has. Didn’t take it all in yesterday - somewhat in shock!

[Rose54]

Hi

I had HA last May

Angiogram done but no stent required

I have been fine just take Meds ,Diet and exercise

[Hidden]

And your arteries were blocked, Rose54? Thanks for reply. Glad you’re ok. I haven’t had HA, just angina so far.

[Rose54 in reply to Hidden]

My report from hospital said no stent required as FFR 0.86 which thay said was ok

[Milkfairy Heart Star]

Hi 123molly

You can have a heart attack without blocked coronary arteries.

Possible causes vasospastic or microvascular angina, coronary artery dissection, Takostubo Cardiomyopathy

[84green]

Hi Molly

Stenosis refers to a narrowing of the artery, usually resulting from a blockage caused by a build up of plaque (this is also referred to as atherosclerosis).

I had a CT angiogram that gave details of which arteries had blockages and to what extent. As a result I was prescribed a statin, aspirin and told the lifestyle changes I needed to make.

I guess that following your angiogram the Dr’s now know the same information about you. Firstly, the fact that you weren’t kept in indicates your condition is not an emergency. You are in the hands of the experts and they will advise you on what they think is best for you; so try not to worry.

I suggest that you write down your questions and concerns and go through them one by one at your next appointment. If it helps, make a note of the answers. You can also call and speak to a BHF nurse during the day.

My understanding is that a procedure is advised if the % blockage is high (others on this forum might have a better idea as to what level this is) or it would help to relieve any symptoms you might have. Otherwise medication and lifestyle changes are advised to try and prevent any blockages from growing. As has been already stated, this has been found to be as effective as surgery in many cases.

This forum is an excellent source of support and shared experiences.

Your circumstances are unique to you and the Dr’s will do what is best for you. Don’t forget, whilst this is a shock to you, it is their day job and they do it very well day in day out.

Good luck.

[Ethel3]

Hi Molly, I had a stent fitted 4 weeks ago and yes I really do feel safer knowing its there. I am currently prescribed Bisoprolol, Ramipril, a statin and medication to prevent the stent getting blocked by platelets. Anticoagulants and anti platelet. I understand that the anti platelet tablets maybe discontinued after 12 months. the rest of the medication can be reviewed and might be reduced or discontinued depending on my condition/progress. I feel taking medication is a small price to pay for a healthy heart.

[Hidden]

Thanks 84green. Lots of good info on this site. Seeing nurse at my GP surgery today

[Plum53]

Hi 123molly, I have 80% blocked LAD artery and I have been given medication . I was told if I get more angina or other symptoms then this could have a stent in the future. I have been on medication since angiogram in November 2016. No change so far and I have been referred back to GP care.

Please let us no what is decided. Good luck going forward X

[Plum53 in reply to Plum53]

Sorry know not no lol

[Hidden in reply to Plum53]

Thanks Plum53. Good luck to you to - sounds like you’re doing well!

[Plum53 in reply to Hidden]

Fingers crossed