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    Do You Really Need Bypass Surgery?

    What to consider if it's not an emergency and your coronary artery disease is stable.

    Angioplasty and Stents continued...

    “For people with single-vessel disease [CAD in only one coronary artery], many times the preferred treatment is angioplasty,” Murrow says.

    During angioplasty, doctors may also insert stents -- mesh tubes that hold the arteries open. Some stents, called drug-eluting stents, slowly release medications that help to prevent the artery from narrowing again.

    With angioplasty, you're not getting your chest cracked open for heart surgery. That means a shorter recovery time.

    But “when you put a stent in an artery, you’re only treating that 1-2 centimeter segment. The rest could be developing plaque,” Murrow tells WebMD.

    Medical Therapy

    If you don’t have very severe CAD, treating it with medicines alone may be an option. These drugs may include aspirin to prevent blood clots; beta blockers to reduce the workload on the heart; ranolazine and nitroglyerine for chest pain; ACE inhibitors for heart failure; and statins for cholesterol.

    A 2007 study of 2,287 patients, known as the COURAGE trial, showed no difference in death or heart attack rates among stable CAD patients treated with medicine alone vs. those treated with angioplasty. Angioplasty, however, was shown to be a more effective treatment of chest pain.

    Lifestyle Changes

    A tobacco-free lifestyle that includes exercise, a diet low in saturated fat and salt, and limited alcohol has long been encouraged to prevent heart disease. However, some studies show that comprehensive lifestyle modifications can not only prevent the disease but also treat it.

    Studies led by Dean Ornish, MD, who is the founder of the nonprofit Preventive Medicine Research Institute and professor of medicine at the University of California, San Francisco, have continually shown the impact of major lifestyle changes on CAD.

    Ornish’s lifestyle plan, which includes a low-fat, whole foods, vegetarian diet; aerobic exercise; stress management; smoking cessation; and group therapy, has significantly reversed CAD in study participants, helped them avoid bypass and angioplasty, decreased heart attack rates, and improved risk factors and quality of life. Medicare recently approved Ornish’s hospital-run programs as a reimbursable treatment for CAD.

    “The problem is most people are told to make moderate changes in the diet, and when it doesn’t do much, they’re told ‘We have to operate.’ But if they’re willing to make bigger changes, most people can avoid surgery and they don’t even know that’s an option,” Ornish tells WebMD.

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