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Beta Blockers May Not Prevent Heart Attacks and Strokes

http://abcnews.go.com/Health/video/beta-blockers-effective-previously-thought-17378539

By SYDNEY LUPKIN
Oct. 2, 2012

New research suggests that beta-blocker pills don’t prevent heart attacks, strokes or cardiac deaths in patients with heart disease, but doctors are torn over whether there’s enough in the study to make them want to stop prescribing the drugs. Beta blockers have been a standard heart medication for decades.

The study, published in the Journal of American Medical Association, looked at nearly 45,000 patients with prior heart attacks, coronary artery disease or risk factors for coronary artery disease, and found that those on beta blockers didn’t show significantly lower rates of heart attack, stroke or cardiac death than those not on the medication.

“This is a very compelling study that has the potential to shake up the conventional wisdom that exists regarding the role of beta blockers in the management of patients with cardiovascular disease,” said Dr. Randal Thomas, a cardiovascular specialist at the Mayo Clinic. “At a minimum, it will lead to new studies that address this issue once again.”

Beta blockers work by blocking adrenalin receptors in the brain that become activated when the body is stressed. Beta blockers are used to treat heart disease, high blood pressure, anxiety and other conditions.

Some doctors say they are glad beta blockers are being questioned because their use had been “written in stone” for so many years, but others say using a non-randomized data sample is not as reliable as a randomized drug trial.

While the authors attempted to account for differences between the patient groups that might have had an impact on their health, they did not have access to information on why some patients were prescribed these drugs and some were not, said Dr. Richard Besser, the chief heath and medical editor at ABC News.

Dr. Melvin Rubenfire, who directs cardiovascular medicine at the University of Michigan, said he’d been hoping for a study like this, but it won’t change his prescribing habits because he uses beta blockers only in specific cases. Rubenfire also weans patients off the pills 18 months after they have a heart attack if they experience adverse side effects, such as fatigue and erectile dysfunction.

Rubenfire said the existing data wasn’t enough to determine which patients would benefit from beta blockers, and what kinds of beta blockers are better than others. Beta blockers include at least six brand names, including Sectral, Tenormin and Zebeta.

Even study coauthor Christopher Cannon, a professor at Harvard Medical School, said he will continue to prescribe beta blockers to his patients, adding “I would not make too much of this” because the study is only observational.

“All it can do is raise up an idea for us researchers to consider for further study,” he said.

Cannon said this research shows that it’s unclear whether beta blockers add more benefit than the other therapies developed in the decades since beta blockers became a standard of practice for treating patients with heart disease. Since patients are often taking several drugs, it’s hard to pinpoint how much one agent helps compared with another.

Dr. Steven Nissen, who chairs the department of cardiovascular medicine at the Cleveland Clinic Foundation, said the medicine might not be ideal for all of the patients it’s prescribed to, but a new randomized, controlled trial will be necessary to change guidelines for prescribing beta blockers.

“Abandonment of this type of therapy for post-MI [post-heart attack] patients based upon an observational study is not warranted,” he said.

For the time being, the study raises questions, said Dr. Harlan Kumhulz, a professor of medicine, epidemiology and public health at Yale University.

“The question it raises is about how long after having a heart attack should patients remain on beta blockers?” Kumhulz said, noting that beta-blocker patients didn’t have better outcomes than the other patients did after the first year. “The study cannot definitively answer that question — but raises doubts about the need to continue to take them for the rest of a patient’s life.”

Dr. Lauren Hughes of the ABC News Medical Unit contributed to this report.

http://abcnews.go.com/Health/beta-blockers-prevent-heart-attack-stroke-study-jama/story?id=17378403#.UG32y5jA-Sp

Heart Surgeons Kill First Man on the Moon: Neil Armstrong

This Tragic Loss Should Become One Giant Leap for Mankind

Neil Armstrong, who made the “giant leap for mankind” as the first human to set foot on the moon, died on Saturday, August 25, 2012. The cause of death according to his family was “complications resulting from cardiovascular procedures.” He had just celebrated his 82nd birthday when he went to the hospital on Monday, August 6, 2012 for a cardiac stress test. He flunked, and on Tuesday surgeons bypassed four blockages in his coronary arteries. This limited information from the media is enough for me to conclude that his death was avoidable; he should have never been operated on. His doctors gambled and we lost an American hero.

The first successful bypass operation was performed in America at the Cleveland Clinic on May 9, 1967, about two years before Mr. Armstrong’s history-making step on the moon on July 20, 1969. Until the mid-1980s, octogenarians (people in their eighties) were spared from heart bypass surgery because the elderly are generally less able to withstand the rigors of extracorporeal circulation (the heart-lung machine) and the many hours of major surgery, than are younger patients. Plus, the life expectancy of people having reached the age of 80 years is limited. Yet, there is the economic side of this equation: doctors and hospitals have increasingly appreciated the market potential of this age group and as a result, have published multiple papers in an attempt to justify taking extreme risks with the elderly.

Open Heart Surgery Does Not Save Lives

There are two indications for heart surgery:

1) To relieve incapacitating chest pain (angina) that is not sufficiently reduced by “good medical therapy.” In standard medical practice, this means giving anti-angina medications like nitrates and beta-blockers. But truly “good medical therapy” must also routinely include a low-fat diet since the frequency of angina episodes is reduced by more than 90% in fewer than three weeks with this simple, safe approach. As an added benefit, this same low-fat diet heals (reverses) the underlying artery disease. A symptom-relieving indication for heart surgery appears to be absent in Mr. Armstrong’s case. He simply had the misfortune to step on a cardiac treadmill machine as part of a routine check up.

2) To save lives. According to the article “Is Heart Surgery Worth It?” in Bloomberg Businessweek, “Except in a minority of patients with severe disease, bypass operations don’t prolong life or prevent future heart attacks,” Even after massaging the data, the survival benefits are barely perceptible: A recent analysis of 28 studies comparing heart surgery with medical therapy, performed by doctors with a vested interest (cardiologists and bypass surgeons), found less than a 2% absolute improvement in survival achieved from heart surgery over no operation. These conclusions are based on relatively young patients. Sadly, the case for octogenarians is much more disappointing.

Multiple studies, performed by researchers, most interested in justifying bypass surgery, have confirmed the higher risks of complications (bleeding, kidney failure, etc.), death, and prolonged hospitalization in octogenarians. An octogenarians’ 30-daymortality rate is 9% compared to 1.2% in the younger group. Surgeons from the same city where Mr. Armstrong died, Cincinnati, know these dismal results as well. J. Michael Smith, M.D., director of surgical research, Good Samaritan Hospital, wrote about his study, “Octogenarians had a 72 percent higher risk of death, 3 percent longer hospitalization, a 51 percent higher risk for neurological complications and were 49 percent more likely to undergo repeat surgery for bleeding…. On the plus side, surgery can improve quality of life, including such symptoms as shortness of breath and chest pain, even in octogenarians. On the other hand, it’s hard to make the argument that you will prolong anyone’s life this way.”

The reason heart surgery (both bypass surgery and angioplasty) fails to save lives is that the targets of the operators are the hard, fibrous, stable, non-lethal plaques, not the volatile small plaques found inside the arteries that rupture and cause heart attacks and death.

Good Can Come from a Hero’s Death

From all accounts Neal Armstrong was strong and healthy with many good years ahead for him. That is before he stepped on the treadmill, which in his case served as the conveyor belt to the operating room, and beyond. His former doctors undoubtedly have regret for their decisions, but not enough to change their ways. They owe the world an explanation for their actions in light of common knowledge held for more than two decades about the extreme risks of lucrative heart surgery in octogenarians. Likely, they will remain silent, continuing to make obscene profits at all costs. (The average annual salary of a bypass surgeon is $533,084.) Let’s hope that this one small step for (a) man will become one giant leap for mankind by publicizing this kind of unconscionable care. No one is immune from these everyday medical practices as Neil Armstrong’s untimely end demonstrates. And let’s dream beyond the moon, hoping that someday soon patients will be offered a time-honored, safe, cost-free, highly effective dietary approach to their health problems.

(Although the kind of stress test used for Neil Armstrong was not identified, the use of a walking treadmill to stress the heart is most commonly employed. If positive, then an angiogram is performed to identify the anatomy of the specific blockages. The angiogram serves as a preoperative test.)

http://www.drmcdougall.com/misc/2012nl/aug/armstrong.htm

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