Stents. Again.

[COYW]

Hi all. Has anyone been watching the Dr Greger videos about the pointlessness and dangers of stenting? I’m interested but would like to see the comeback to his videos from open minded and progressive cardiologists. It’s too late now of course for many of us with stents but I’m wondering if 70% blockage of LAD warranted two stents given that I had no symptoms. Anyone know where I can read a level headed assessment? Thanks all 🙏🏻

[Hidden]

Thought this was an April fool for a minute 🤔

[COYW in reply to Hidden]

It’s not a joke. I’m asking for help.

[Hidden in reply to COYW]

Apologies.

[gilreid1]

Started reading your post and was about to explode when reading pointless and dangerous. Then realized today’s date. Well done you got me 🤦‍♂️😂

[gilreid1]

Sorry what are you asking help with ? I had HA and emergency stent done (saved my life ) six weeks later triple bypass. I also had no signs of health problems prior. Will be glad to offer advice if you can be more specific of your current issues

Gil

[COYW]

nutritionfacts.org/video/wh...

[Grey24 in reply to COYW]

I am always sceptical of any online medical 'experts', not least because you always seem to be able to find opposing views if you look hard enough. With regard to this particular video, all I can say is that is is completely at odds with my own personal experience. As a fit and active 67 year old man in 2017, I found that I was progressively experiencing shortness of breath on exertion, which became severe, leading to a visit to the GP, a diagnosis of angina, and a referral to a cardiologist. In December 2019, I had angioplasty and a stent inserted into my LAD. The improvement was immediate and life changing. I am fitter now than at any time in the last 5 years and am back to cycling 100km a week.

I can't help thinking that my quality of life is far better than if I had only the option of managing my condition medically. In a sense, I am doing that as well, with the usual cocktail of drugs, which I see as my best option for slowing down my atherosclerosis. I have also radically improved my diet, whilst carefully avoiding the plethora of opposing Youtube experts' contradictory opinions, relying instead on common sense and BHF advice.

[COYW in reply to Grey24]

Thing is, Greger does support his comments with ‘evidence’. I’m a researcher so know how ‘evidence’ can be handled. But nonetheless, I think his video about stents can only lead me to believe I was stented unnecessarily. That was the point I was try to make.

[COYW]

I asked if anyone had seen the Dr Greger videos. They contain the information I’m reacting to. My post asks if anyone has some level headed reactions to the kinds of evidence Dr Greger puts forward. So to help, you need to watch the video.

[gilreid1 in reply to COYW]

Ok I have now read this Dr and the obvious thing is he is not a cardiologist. He talks about prevention. So what about those of us who had no idea we had a problem? Hind sight is a wonderful thing. I also try not to watch or listen to American Quacks as and in this case are all monetary driven. This is my opinion and I know many follow such people. Sorry not for me.

Stay safe

Gil

[Tyronefitsimmons in reply to COYW]

Dr Greger video must be an april fools day joke, he has not proven beyond a doubt his theory, as such, just where would we be with out stenting, its a proven life saver, with out stenting you be having massive open heart surgery, the pain of it ,!!!!

[Chappychap]

I don't think there can be any doubt that stents have saved countless lives. You only have to look at the frighteningly low survival rate for heart attacks before stents were available, and then compare that more recently when stenting is routinely performed on heart attack victims.

As Gilreid said, he believes stenting allowed him to survive a heart attack and bought him the time to wait for a heart bypass. I've no reason to doubt his conclusion.

But you're right that when it comes to ELECTIVE surgery the evidence is pretty thin that stents deliver much benefit. It's sobering when you have the Royal Brompton going public with their concerns,

rbht.nhs.uk/invasive-proced...

My take out from all this is that it underlines the importance of life style changes for heart disease patients. Relying on stents to somehow "fix" heart disease would be a huge mistake, the onus is still on the patient to help themselves by changing their life style and working with health care professionals to optimise their medication. Stents (and for that matter bypass surgery) do nothing to arrest or even slow down atherosclerosis. They buy time, they offer a second chance, but unfortunately they don't fix us..

[COYW in reply to Chappychap]

Agreed and thanks. Probably I was stented too soon. I expect I should have dealt with the blockage with diet and statins.

[SpiritoftheFloyd in reply to Chappychap]

Thank you for the link, very interesting.I had a heart attack, closely followed by cardiac arrest before they could start to fix the problem, and ended up with one stent(LAD). As you say in your final paragraph, a stent does not fix the problem, the problem will still be there. This fact and what I needed to do was fully explained to me while I was in hospital and subsequently in the health talks at cardio rehab.

I always think I was very lucky to be able to walk out of that hospital and have changed my life style totally as a result.

[Chappychap]

"I expect I should have dealt with the blockage with diet and statins."

I'm not sure you should have any regrets. There's precious little evidence that anyone has ever actually reversed atherosclerotic blockages with diet or statins. Certainly the view of the BHF is that damage is irreversible.

So even though life style changes may slow the progress of our heart disease to an absolute crawl, it could be that you needed the remedial effects of your stents to free you from the symptoms of angina, and give you that precious "second chance" to live a healthier life style.

Good luck!

[Hidden]

Thanks. I had to smile, Dr Greger’s presentation style reminded me of Woody Allen. He appears to be a physician, it’s notable that all proceeds go to charity. Can you point us towards where he has the answers? Statins and other anti inflammatory strategies in at risk young middle aged people seem the answer to me.Stents are a fix but do they improve mortality in the long term?

oooooooooooooo

Michael Greger M.D. FACLM. Dr. Greger is a physician, New York Times bestselling author, and internationally recognized speaker on nutrition, food safety, and public health issues. A founding member and Fellow of the American College of Lifestyle Medicine, Dr. Greger is licensed as a general practitioner specializing in clinical nutrition. He is a graduate of the Cornell University School of Agriculture and Tufts University School of Medicine. In 2017, Dr. Greger was honored with the ACLM Lifestyle Medicine Trailblazer Award and became a diplomat of the American Board of Lifestyle Medicine.

His latest books —How Not to Die, the How Not to Die Cookbook, and How Not to Diet — became instant New York Times Best Sellers. His two latest books, How to Survive a Pandemic and the How Not to Diet Cookbook were released in 2020. View the trailer for How Not to Die here, and for How Not to Diet here. 100% of all proceeds he has ever received from his books, DVDs, and speaking engagements have always and will always be donated to charity.

[gilreid1 in reply to Hidden]

Yes correct but you are missing one important part. They are his own charities which in turn gives you massive tax benefits in the USA.

[Milkfairy Heart Star]

Hello,

Here's another article about the Ischemia trial.

medscape.com/viewarticle/92...

It was a large long term trial.

'The ISCHEMIA trial showed that an invasive approach to patients with moderate to severe ischemia did not significantly reduce a composite endpoint of myocardial infarction (MI), cardiovascular (CV) death, hospitalization for unstable angina or heart failure, and cardiac arrest compared with a conservative medical strategy—without initial angiography.'

If you are asking are too many stents inserted perhaps yes. However there are no large trials equal to the ISCHEMIA trial that shows life style and diet alone can have the same outcome as medication, stents,or surgery then probably not.

Another thought.

6 % of heart attacks are caused by non obstructive coronary artery disease such as microvascular dysfunction and vasospastic angina.

Patients living with ischaemia non obstructive coronary arteries INOCA have an increased risk of heart attacks, stroke and heart function.

[COYW in reply to Milkfairy]

I don’t follow those last two paras. Can you explain brown please? 🙏🏻

[Milkfairy Heart Star in reply to COYW]

You can have ischaemia or angina without blockages or permanent narrowing to your coronary arteries. Not everyone can eat their way out of heart disease.

It is not just about the blockages seen during an angiogram. The way the blood flows through the blood vessels is used to assess whether a stent should be inserted.

The ISCHEMIA trial suggested that surgery, stents or medication had the same outcomes.

So the use of stents for stable angina is debatable. It did not show that diet and lifestyle changes alone were as effective.

Other factors to consider are healthcare is organised differently in other parts of the world.

If your income depends on the number of procedures you perform will that influence your decision making ?

Does Dr Greger have any conflict of interest or profit indirectly from his book sales?

[Bloodsimple]

A lot of what Dr G (who specialises in nutrition) says is aimed at the US health set up, which is at the opposite end of the spectrum to the NHS. He is a committed Vegan, which I am not, however, I think his advice on nutrition and exercise is practical and would help many people who contribute to these conversations. I think his point about stents is mainly looking towards US practices, where there appears to be little in the way non invasive/chemical intervention. Sadly it appears to be heading that way in Europe, not so much for financial gain by medical staff and pharmaceuticals, as for the need to treat epidemic proportions of overweight/obese related illnesses