by Al Lewis
Roughly 1.8-million stents are implanted in Americans every year. If this seems like a large number, that’s because it is. To put it in perspective, it seems like everyone you know is having children or grandchildren. Yet the number of babies born – 3.8 million in a typical year – isn’t much more than twice the number of stents implanted. At current rates, then, one of those babies has almost a 50% chance of having a stent implanted. (A little less than that, because some people account for multiple stents, the official record being 34 and the unofficial record being 63.)
Could it really be the case that humans are so ill-evolved that without stents we would all get clogged arteries and die?
It turns out that a considerable number of these elective stents (as opposed to emergency cardiac stents, which can be life-saving) add no value whatsoever, except to the cardiologist’s or vascular surgeon’s bank accounts. Here are Six Things employees need to know before getting a stent implanted in their legs or coronary blood vessels.
1. Don’t get a “free” screening by your local hospital or by an unlicensed vendor at a local community center
These screenings, detailed in Marty Makary’s The Price We Pay, are specifically designed to generate insurance revenue for follow-up stents. (Insurers have figured out not to cover these inappropriate vendor-initiated screenings, which is why they need to be so cheap, or free, to begin with.)
Sketchy as these screens are, one would think vendors would be wise enough not to pitch them to Quizzify’s CEO. And yet Life Line did. When our CEO called back, a “preventative health advisor” answered the phone. He asked her if these screens were A-rated by the US Preventive Services Task Force. She replied: “That is very very very true.” Actually, that is very very very false. USPSTF says there is no data to support this screen.
2. Cardiac stents are no more effective than drugs and lifestyle improvements
A highly anticipated, large-scale, controlled study showed exactly that. Note this is only for people with “stable” angina. However, that is the large majority of people with angina. Obviously, if you have unstable angina and need an emergency stent, this study does not apply to you. (Nor would you be reading this post right now.)
3. Long-term outcomes for cardiac stents are the same regardless of whether you get a stent or not.
That study compared drugs-and-lifestyle- improvements to stents. Another study did “sham surgeries” on half the volunteers while giving the other half stents. After 6 weeks, a cardiac test showed no difference in outcomes between the people who got stents and the people who didn’t. This came as quite a surprise to cardiologists who had been doing stents for decades. The number of stents didn’t fall after this study came out. The industry expects "low single-digit growth" in stents for the next several years – even though they don’t appear to accomplish anything.
4. Stents for peripheral artery disease (meaning in your legs) offer basically the same outcomes as not having stents
This may be the single most overused procedure in all of surgery, though there is plenty of competition for this honor. As mentioned in the link, to control PAD, you should stop smoking and walk every day. And you should also work with your doctor to control other risk factors, such as diabetes, high blood pressure, and high cholesterol.
Even if you have symptoms, you may be better off not having a procedure. Studies show that walking every day can relieve symptoms just as well as angioplasty, in some cases. Try that first.
5. Stents create a long-term commitment.
Stents are not a one-and-done procedure, like an appendectomy. Your appendix isn’t going to grow back after it is removed. But your arteries could clog right back up again after they are cleared -- and some people’s do. Your odds of having this happen are lower if you take meds as prescribed. However, those meds come with their own side effects. If you are taking anti-clotting medicines – even something as simple as a little aspirin – your risk of bleeding goes way up, if you are in an accident. We’ve all seen doctor shows on TV where someone shouts: “He’s a bleeder!” Well, that could be you.
6. Stents create their own set of risks.
Someone fiddles with blood vessels surrounding your heart…and then you spend the rest of your life with little tubes in those vessels. How could anything possibly go wrong?
While stents are about as safe as heart surgery gets, heart surgery (or surgery in general) comes with many risks. In addition to re-narrowing of the blood vessels, blood clots can form at the site of the stent. Or the reverse, bleeding.
So, as with everything else in Quizzify (except for whole-body scans, where we do just say no), we don’t just say no. We say: “Consider both the risks and especially the alternatives, and discuss them with a trusted advisor and/or your primary care physician. As we say about many things, just because it’s health care doesn’t mean it’s good for you.”