Some may think that having a coronary artery disease or a heart attack is not that big of a deal. That is because there are medical procedures that can open up a blocked artery. One way is to have a coronary stent. A coronary stent is a medical device that is inserted inside the blood vessels that supply the muscles of the heart (coronary artery). Doing so increases the blood flow again and prevent heart damage.
However, it is wrong to think that after having a coronary stent placed, then everything will be back to normal.
Coronary stents can get blocked. Since stents are man-made and foreign, the body will try to wall it off by developing new cells on top of it. That is why some stents are made with drugs in them (Drug-Eluting Stents) to prevent these cells from forming.
Stents are not as smooth as the inner lining of the blood vessels. Blood clots tend to form inside the stent and lead to another heart attack.
Blood Thinners to Prevent Clot Formation Inside the Stent
That is why 81 mg of aspirin a day should be taken together with another blood thinner like clopidogrel (Plavix™) or ticagreclor (Brilinta™) for at least 12 months. That is in the 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes (6.2.1.2). The aspirin has to be taken indefinitely.
A few weeks ago, I wrote an article about the Number Needed to Treat (NNT). NNT is the number of people needed to be treated by a drug for 1 person to benefit. The lower the number, the better. There is an opposite of NNT, and that is called NNH. Number Needed to Harm (NNH). NNH is the number of people needed to take that medicine for one person to have a significant side effect or harm. In contrast to NNT, a low NNH number is terrible.
For the aspirin/clopidogrel combination, the NNH is 1 in 114. For the aspirin/ticagrelor combination, the NNH is 1 in 166. That means, in 166 patients who will receive the aspirin and ticagrelor, 1 will be harmed.
The “harm” in both situations is a significant bleeding event most commonly from the gastrointestinal tract requiring hospitalization and blood transfusion/s. 1 in 16 patients in the aspirin/ticagrelor combination also developed shortness of breath.
It is noteworthy to look again at the NNT of the aspirin/ticagrelor because the third-party, independent meta-analysis shows that “No patients were helped.” So what is the basis of the AHA/ACC for the recommendation? They are from the two studies. Namely this and this. Both funded by AstraZeneca. The same company that makes ticagrelor. I wrote a little bit about the ACC in this article, Are You Skipping Breakfast?
Elective Surgeries will Just Have to Wait
After an angiogram, it is also best to postpone any elective surgery for at least a month or while the patient is on double blood thinners. That is because the blood thinners should not be stopped or else a blood clot can form within the stent and lead to a heart attack. If there is a need to have emergency surgery for some reason, then the surgeon will have to weight what matters more. Stopping the blood thinner and risk a heart attack or go ahead with the surgery and risk bleeding.
As of August 2019, the monthly price for Brilinta is $379 and Plavix is $11-$156.
Medical Conditions Need Medications and Procedures that may have side effects that will need more medications that will have side effects that will require more drugs and so on and so forth.
In summary, the management of coronary heart disease is complicated. The possibility of complications with any medical procedure always exists. With regards to a stent, there is the danger of clot formation inside the stent and another heart attack. Therefore a blood thinner should be taken to prevent blood clots. The blood thinner then introduces the possibility of bleeding that can come from the stomach and/or the brain.
Real risks always exist whether a heart attack is treated conservatively with medications or aggressively with a clot-buster to dissolve blood clot or with a heart bypass. Medications have to be taken to deal with the side effect of the other prescription drugs. This article serves as an example of the complexity of medicine and the shortcomings of medications. Most medications, whether they be over the counter or prescribed, bring with them the possibility of an unexpected and unwanted drug-drug and drug-patient interactions.
Take Away Message
Disease prevention is much better than being sick. There is almost no risk at all in eating a low carbohydrate diet. Even with intermittent fasting. The NNT of the Mediterranean diet to prevent a heart attack is 18, and no one was harmed. 1 in 18 benefited but all had a great meal. The NNT for statins for preventing another heart attack in someone who already had a heart attack is 39, and the NNH for muscle damage is 10 and an NNH of 50 for developing diabetes.
The risk associated with exercise that is done with the right technique and in a safe environment is almost none.
A low carbohydrate diet and exercise does not only prevent coronary conditions but also the other diseases associated with metabolic syndrome.
Thanks for reading. Feel free to share, like, and comment.
Don’t Get Sick!
Related Readings:
- The Deadliest Diseases Associated with Metabolic Syndrome
- Atrial Fibrillation and Metabolic Syndrome
- How Effective are Drugs that Increase HDL?
- Can You Be in Heart Failure Now?
- What Starts Atherosclerosis?
- The Magical Endothelium
- How Does Diabetes Destroy Arteries
- How Diabetes Destroys the Body
- Understanding Heart Failure Treatment
- How Effective is Quitting Cigarettes?
- Hair Loss and Heart Attacks
- The Real Effect of Statins on Heart Disease
- LDL: “Bad Cholesterol” is Not All Bad.
Image Credits:
Coronary Stent from the NIH
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