How should you be keeping your heart healthy? Recent headlines have brought some controversies in cardiology to public attention.
The American College of Cardiology and the American Heart Association issued guidelines on blood pressure control in 2017 (Hypertension, online Nov. 13, 2017). These cardiology groups recommend that anyone with blood pressure above 130/80 should be considered hypertensive. That means about 46 percent of American adults fall into that category. While not everyone should be prescribed medication to lower their blood pressure into the target range, far more people will be on antihypertensive drugs than previously. What are the pros and cons of this policy?
Every year, more than half a million people in North America and Europe get a stent in a coronary artery. Most of these patients expect that a stent will significantly improve their quality of life. But a recent study, called ORBITA (for Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty), calls this assumption into question (The Lancet, Jan. 6, 2018). This study was unusual because it had a control group of people who received sham angioplasty. The actual stent was no more effective than the placebo at improving exercise. The topic of stents is one of the current controversies in cardiology.
We discuss the use of placebo in studies of surgical interventions, who will actually benefit from stents, how blood pressure treatment can prevent strokes, and why cardiologists (and other humans) tend to cling to their conceptions of what works and what doesn't. How can we evaluate such controversies in cardiology?
Steven Nissen, MD, is chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at the Cleveland Clinic. He is the co-author, with Mark Gillinov, MD, of Heart 411: The Only Guide to Heart Health You'll Ever Need. The photo is of Dr. Nissen. You can listen to previous People's Pharmacy interviews with Dr. Nissen here, here and here.
Robert DuBroff, MD, is Clinical Professor of Medicine in the Division of Cardiology at the University of New Mexico in Albuquerque, NM. He is board-certified in internal medicine and cardiology and has a specialty in lipidology. His article on confirmation bias was published in QJM, Nov. 2, 2017.