Q During a health check-up, I was found to have approximately 50 to 70 per cent blockage of my heart artery on the computed tomography (CT) scan.
Do I need to proceed to have coronary angioplasty and stenting?
I hear that once you get a stent, you will need to be on medication for life. Is this true? How else can I treat my condition?
A The blood vessels of the heart are known as coronary arteries and they can get blocked due to atherosclerotic plaque build-up inside.
Blocked arteries may reduce the flow of blood to the heart muscle, leading to a weak heart or, in serious cases, heart attacks or sudden cardiac death.
One of the methods of treating blocked coronary arteries is by inserting catheters to treat the narrowed portion with balloon angioplasty, followed by stent insertion.
Although this procedure is life- saving in the setting of an acute heart attack, it is a common misconception that all blocked coronary arteries need to be treated this way.
In fact, treating mild to moderate blockages this way has not been shown to lower the risk of future heart attack or death from heart disease, and may do more harm than good.
In order to determine whether coronary angioplasty is required for your blocked artery, it is best to get a cardiologist to assess you carefully with a detailed history and physical examination.
Further tests evaluating the heart function, such as stress echocardiography or myocardial perfusion imaging, can be used to assess the impact of blocked arteries.
If function is not significantly affected, then it is less likely that invasive intervention is required.
Coronary angioplasty itself is not without risks and should not be undertaken lightly.
Furthermore, once a stent has been implanted, it is permanent and the patient is likely to require lifelong medications, including one or more blood-thinning agents which might increase the risk of bleeding.
Blocked arteries which cause minimal or no symptoms and are not affecting heart function are amenable to therapeutic lifestyle changes.
Lifestyle medicine is a scientifically proven branch of medicine that harnesses the therapeutic power of lifestyle to prevent, treat and even reverse lifestyle- related chronic diseases.
Instead of conventional drug treatments, the focus is on physical activity, nutrition, stress management, adequate sleep, social support, and tobacco and alcohol cessation.
Exercise and food can be used as medical therapies, but the appropriate type and dose for individuals need to be tailored to yield optimal results.
Many studies in patients after heart attack demonstrate that aggressive lowering of cholesterol with statin medications can lead to stabilisation and even shrinkage of plaques.
This effect is further enhanced when used together with adequate lifestyle changes, leading to greater reversal of blockages.
These reversal programmes are usually delivered by cardiologists specially trained in preventive cardiology and rehabilitation, with the help of a multi- disciplinary healthcare team.
Dr Peter Ting
Senior consultant cardiologist at The Harley Street Heart & Cancer Centre
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