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clearly demonstrated that the three-year survival rate for heart disease patients undergoing bypass surgery
is almost the same as for patients who have no surgery.
According to numerous heart disease studies, most heart attacks do not occur because an artery is
narrowed by plaque. Instead, researchers say, heart attacks occur when an area of plaque bursts in a
coronary artery, causing formation of blood clots that abruptly block blood flow to the heart. In fact, in 75
to 80 percent of cases, the hardened plaque obstructing an artery is not a culprit and should not even be
considered for bypass surgery or stenting. The most dangerous type of plaque is soft and fragile. It
produces no symptoms and would not even be seen as an obstruction to blood flow. The soft, newly-
formed patches of plaque are much more likely to break off than old, hard ones; and when they do, blood
clots are formed that enter the heart, causing a heart attack. Therefore, creating a bypass around the
hardened parts of an artery does nothing to lower the risk of a future heart attack. For this reason, many
heart attacks occur in people who don't have any arterial occlusions. Accordingly, a person may have no
problem jogging one day, but suffer a heart attack (or stroke) the next day. If a narrowed artery were the
culprit, the person would not even be able to exercise due to severe chest pain or breathing restriction.
Most heart patients have hundreds of vulnerable plaque sites in their arteries. Since it is impossible to
replace all these injured, plaque-ridden sections, the currently applied interventional procedures are
unable to prevent heart attacks. Regardless, this doesn't mean that fewer bypasses or stent operations are
performed. The multi-billion dollar stent business seems, in fact, unstoppable.
Heart researchers and some cardiologists are becoming increasingly frustrated with the fact that their
findings are not being taken seriously enough by the health practitioners and their patients. "There is just
this embedded belief that fixing an artery is a good thing," said Dr. Eric Topol, an interventional
cardiologist at the Cleveland Clinic in Ohio. It has almost become fashionable to have one's arteries fixed,
just in case. Dr. Topol points out that more and more people with no symptoms are now getting stents. In
2004, over one million Americans opted for a stent operation.
Although many doctors know that the old heart disease theory no longer holds true, they feel pressured
to open blocked arteries anyway, regardless of whether patients have symptoms or not. Dr. David Hillis,
an interventional cardiologist at the University of Texas Southwestern Medical Center in Dallas,
explained: "If you're an invasive cardiologist and Joe Smith, the local internist, is sending you patients,
and if you tell them they don't need the procedure, pretty soon Joe Smith doesn't send patients any more.
Sometimes you can talk yourself into doing it even though in your heart of hearts you don't think it's
right."
According to Dr. Topol, a patient typically goes to a cardiologist with a vague complaint like
indigestion or shortness of breath, or because a scan of the heart indicated calcium deposits or a buildup
of plaque. Doing his job, the cardiologist follows the standard procedures and puts the patient in the
cardiac catheterization room, examining the arteries with an angiogram. If you live in a developed country
like America and are middle-aged or older, you are most likely to have arteriosclerosis, and the angiogram
will show a narrowing. It won't take much convincing to tell you that you need a stent. "It's this train
where you can't get off at any station along the way," Dr. Topol said. "Once you get on the train, you're
getting the stents. Once you get in the cath lab, it's pretty likely that something will get done."
Dr. Hillis believes the American psyche is convinced that the worth of medical care is directly related
to its aggressiveness. Hillis has tried to explain the evidence to his patients, but with little success. "You
end up reaching a level of frustration," he said. "I think they have talked to someone along the line who
convinced them that this procedure will save their life. They are told if you don't have it done you are,
quote, a walking time bomb."
Even more disquieting, Dr. Topol said, is that stenting can actually cause minor heart attacks in about 4
percent of patients. This means that, out of the 1 million stent patients in 2004, 40,000 ended up suffering