From Ronald Hoffman, MD
Each year we make a big to-do about American Heart Month. We’re reminded to eat well, exercise, get our cholesterol and blood pressure checked, and see if we suffer from blood sugar problems.
And yet, trends are concerning. We’re making progress in preventing heart attacks, and we’re keeping people with heart disease alive longer through advanced techniques. Smoking rates are down dramatically. You’d think we’d be doing better.
But in actuality, over the past few years, Americans are now experiencing diminished life expectancy, reversing a decades-long trend toward increasing longevity. We now lag far behind other advanced countries, and the gap is widening.
We spend way more per capita on medical care than other countries—we’re simply not getting enough bang for our buck. We perform over two million heart stenting procedures per year to unblock arteries with a tiny metal scaffold, and a quarter of a million bypass surgeries.
But stents are vastly over-performed, according to many analyses. Helpful in “acute coronary syndromes” when not enough blood is reaching the heart (as during a heart attack), PCI, as it’s referred to, can be lifesaving. But in patients with stable coronary disease, even with known blockages, medical management delivers equivalent outcomes. Despite research reinforcing this, about 75% of stents placed in US hospitals from 2015-2017 were for stable heart disease. Reducing unnecessary stents could save us as much as six billion dollars in health care costs annually. But defensive medicine, enthusiasm for new technology, and a profit-driven health care system perpetuate this over-reach.
And a recent UK study showed that stents—often done to address heart failure—confer no benefit whatsoever. 60,000 excess procedures are done unnecessarily on heart failure patients in Britain alone.
To compound harm and waste, we’re playing cholesterol-limbo (“How low can you go?”) with escalating calls for “intensive lipid-lowering;” LDL cholesterol targets have become ever more aggressive. Less than 130 used to suffice; now powerful new PCSK-9 drugs have enabled goalposts to be moved to LDL 30 or less!