Health A to Z

Seniors' Health: Medication is enough for chronic chest pain

Study shows no added benefit from a procedure to open narrowed blood vessels

People who suffer from angina — chest pain caused by narrowing of the arteries feeding the heart — can often get by on medication alone, a recent study has shown.

The study involved nearly 2,300 people who had stable angina, which gets better with rest. However, nearly 40 per cent had already suffered a heart attack. The researchers put everyone on the latest heart medications, including statins, antiplatelet therapy, beta-blockers, calcium channel blockers and angiotensin converting enzyme inhibitors. In addition, participants signed up for weight loss, smoking cessation, exercise and diet counselling programs.

Half of the study participants were then randomly assigned to undergo angioplasty and stenting, a procedure in which devices are inserted into the narrowed arteries to clear the blockages and prop the vessels open.

During the next four years, about 20 per cent of people in the medication-only and medication-plus-angioplasty groups died or had a non-fatal heart attack or stroke. And after five years, about three-quarters of the patients in each group were free of angina. In other words, adding angioplasty on top of medical therapy didn’t produce any additional benefit.

However, Dr. William Boden, the study’s lead author and a cardiologist at Buffalo General Hospital in New York State, stresses that angioplasty and stenting have been established as clearly beneficial for people who have just had a heart attack, or have uncontrolled angina.

Boden adds that the findings support current guidelines, which recommend medication and lifestyle management first, followed by angioplasty and stenting, or bypass surgery, if those measures are ineffective.