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Surgery for Blocked Arteries Is Often Unwarranted, Researchers Find by GINA KOLATA


By GINA KOLATA

Drug therapy alone may save lives as effectively as bypass or stenting procedures, a large federal study showed.

Published: November 16, 2019 at 05:30AM

from NYT Health https://ift.tt/3761G2R

New top story from Time: President Trump Undergoes Testing During Medical Checkup Not Listed on His Public Schedule: White House

BETHESDA, Md. — President Donald Trump spent more than two hours at Walter Reed National Medical Center on Saturday for what the White House said were medical tests as part of his annual physical.

The appointment wasn’t on Trump’s weekend public schedule, and his last physical was in February. Press secretary Stephanie Grisham said the 73-year-old president was “anticipating a very busy 2020” and wanted to take advantage of “a free weekend” in Washington to begin portions of his routine checkup. She was not more specific about the testing.

Trump’s 2018 and 2019 physicals were announced in advance and appeared on his public schedule.

The February checkup showed he had put on some pounds and was now officially considered obese. His Body Mass Index was 30.4. His weight was 243 pounds and he was 6 feet, 3 inches tall.

Trump spent more than four hours at Walter Reed on Feb. 8 for his most recent checkup, supervised by Dr. Sean P. Conley, his physician, and involving a panel of 11 specialists.

“I am happy to announce the President of the United States is in very good health and I anticipate he will remain so for the duration of his Presidency, and beyond,” Conley wrote afterward.

Test results came out six days later, showing that he weighed 243 pounds, compared with 236 pounds in September 2016 before he became president.

An index rating of 30 is the level at which doctors consider someone obese under the commonly used formula. About 40 percent of Americans are obese. That raises their risk for heart disease, diabetes, stroke and some forms of cancer.

Trump doesn’t drink alcohol or smoke. His primary form of exercise is golf.

The physical testing came as House investigators on Capitol Hill interviewed a White House budget official as part of the impeachment inquiry.

New top story from Time: 5 Family Members, Including 3 Children Dead in Apparent Murder-Suicide in San Diego

(SAN DIEGO) — Five members of a family, including three young boys, have died and another boy was hospitalized with injuries in an apparent murder-suicide in San Diego.

Police received a 911 call early Saturday in which dispatchers heard the sound of arguing in the background, Lt. Matt Dobbs said. As officers headed to the house in the Paradise Hills neighborhood in southeastern San Diego, a relative who lives next door called 911 and reported hearing arguing and what sounded like a nail gun being fired.

Dobbs said when officers arrived, they found a 3-year-old boy, a 29-year-old woman and a 31-year-old man dead inside. A 5-year-old boy and 9-year-old boy were taken to the hospital where they were pronounced dead.

An 11-year-old boy was also taken to the hospital to undergo surgery. His condition has not been released.

A gun was found in the house. Investigators didn’t say which family member fired the shots but believes that person is now dead.

Dobbs said a mother and four children lived in a unit next to a main house occupied by other family members.

Neighbors told the San Diego Union-Tribune they often saw the boys outside playing with their dog or riding their bicycles.

“They were just living the kid’s life on the outside, but who knows what goes on behind closed doors,” said neighbor Gabriel Durazo.

New top story from Time: Last Survivor of 1937 Hindenburg Disaster Dies at Age 90

(CONCORD, N.H.) — The last remaining survivor of the Hindenburg disaster, who suffered severe burns to his face, arms and legs before his mother managed to toss him and his brother from the burning airship, has died.

Werner Gustav Doehner, the last among 62 passengers and crew who escaped the May 6, 1937, fire, was 90. The fire killed his father, sister and 34 others. He was just 8 years old at the time.

“He did not talk about it,” his son Bernie Doehner said, adding that his father took him years later to visit the naval station where the disaster happened but not the Hindenburg memorial itself. “It was definitely a repressed memory. He lost his sister, he lost his dad.”

A church service was held Friday for Werner Doehner, who died on Nov. 8 at a hospital in Laconia, New Hampshire.

As the 80th anniversary approached in 2017, Doehner told The Associated Press that he and his parents, older brother and sister were all on the 804-foot-long (245-meter-long) zeppelin traveling to Lakehurst Naval Air Station in New Jersey. The airship departed on May 3, 1937. Doehner’s father headed to his cabin after using his movie camera to shoot some scenes of the station from the airship’s dining room. That was the last time Doehner saw him.

As the Hindenburg arrived, flames began to flicker on top of the ship. Hydrogen, exposed to air, fueled an inferno.

“Suddenly, the air was on fire,” Doehner recalled.

“We were close to a window, and my mother took my brother and threw him out. She grabbed me and fell back and then threw me out,” he said. “She tried to get my sister, but she was too heavy, and my mother decided to get out by the time the zeppelin was nearly on the ground.”

His mother had broken her hip.

“I remember lying on the ground, and my brother told me to get up and to get out of there,” he recalled. Their mother joined them and asked a steward to get her daughter, whom he carried out of the burning wreckage.

Doehner would remain in the hospital for three months before going to another facility in New York City for skin grafts.

The U.S. Commerce Department determined the accident was caused by a leak of the hydrogen that kept the airship aloft. It mixed with air, causing a fire.

Doehner and his family were on their way back to Mexico City, where his father was a pharmaceutical executive. Funerals were held for his father and sister there.

Doehner was born in Darmstadt, Germany, and grew up in Mexico City. In 1984, he moved to the United States to work for General Electric as an electrical engineer, according to his obituary. He also worked in Ecuador and Mexico. He retired from New England Electric System in Westborough, Massachusetts, in 1999.

He moved to Parachute, Colorado, in 2001. He and his wife of 52 years, Elin, moved to Laconia in May 2018.

New top story from Time: Czechs Use 30th Anniversary of Velvet Revolution to Pressure Prime Minister to Sell Business

(PRAGUE) — About a quarter of a million Czechs gathered on the 30th anniversary of the Velvet Revolution that brought an end to decades of communist rule in the country to give Prime Minister Andrej Babis an ultimatum — sell your business or quit your job.

Protesters from across the Czech Republic attended Saturday’s demonstration, the second massive protest opposing Babis at Letna park, the scene of massive gatherings in 1989 that greatly contributed to the fall of communism.

Police estimated some 250,000 people attended the demonstration.

The demonstrators see the populist billionaire and his ally, pro-Russian President Milos Zeman as a threat to democracy. They have given Babis a deadline of Dec. 31 to get rid of his business and media empire or resign.

“We won’t give up until you’re gone,” said Mikulas Minar, a student who put his studies on hold to lead a group called Million Moments for Democracy that organizes the demonstrations against Babis.

Babis was required to transfer ownership of his businesses that includes a conglomerate of some 250 companies and two major newspapers to two trust funds in February 2017.

But his critics, including Transparency International, say he still maintains control and a preliminary European Union report leaked to media concluded the same, saying Babis is in a position to influence the EU subsidies companies receive.

Babis denies wrongdoing and says there’s no reason for him to resign.

“It’s great that people can express their view and nobody persecutes and attacks them,” Babis said.

Over 250,000 were at the previous rally at the same place in June which was considered the biggest anti-government protest since the end of communism.

“Resign, resign,” the crowd chanted, facing a banner on the big stage that read “We want healthy democracy.”

Babis also faces allegations that he collaborated with Czechoslovakia’s secret police before 1989, and has been criticized for his government’s power-sharing deal he signed July 10 last year that gave the Communist Party a role in governing for the first time since the Velvet Revolution.

The Communists are not part of the minority coalition government of Babis’ centrist ANO movement and the left-leaning Social Democrats but enabled the government’s creation by supporting it in a confidence vote.

Babis’ movement won the parliamentary election on October 2017 but his first minority government lost a confidence vote in January 2018 and had to resign. Zeman asked him to form a government again.

“I’m here because I consider Babis and Zeman an evil,” said Zbynek Fiedler, who traveled 350 kilometers (220 miles) from the eastern city of Ostrava to Prague with friends.

“They destroy our society,” the 68-year-old pensioner said.

The organizers are set to announce a new wave of protests on Jan. 7 if Babis doesn’t meet their demands.

New top story from Time: Florida High-Speed Train Strikes SUV, Kills Woman

(AVENTURA, Fla.) — Florida authorities say a woman died when her SUV was hit by a high-speed train at a railroad crossing.

Authorities told news outlets that a woman was driving a Mercedes SUV Friday afternoon near the suburb of Aventura and was trying to cross the tracks when a Brightline train struck her. She was pronounced dead at the scene, but her name has not been released.

Federal Railroad Administration records show that 11 people were killed by Brightline high-speed trains between Jan. 1 and May 31. Media reports show at least eight more deaths since then.

Brightline connects Miami and West Palm Beach.

New top story from Time: Big Study Finds Many Heart Procedures Won’t Cut Risk of Having Heart Attack

(PHILADELPHIA) — People with severe but stable heart disease from clogged arteries may have less chest pain if they get a procedure to improve blood flow rather than just giving medicines a chance to help, but it won’t cut their risk of having a heart attack or dying over the following few years, a big federally funded study found.

The results challenge medical dogma and call into question some of the most common practices in heart care. They are the strongest evidence yet that tens of thousands of costly stent procedures and bypass operations each year are unnecessary or premature for people with stable disease.

That’s a different situation than a heart attack, when a procedure is needed right away to restore blood flow.

For non-emergency cases, the study shows “there’s no need to rush” into invasive tests and procedures, said New York University’s Dr. Judith Hochman.

There might even be harm: To doctors’ surprise, study participants who had a procedure were more likely to suffer a heart problem or die over the next year than those treated with medicines alone.

Hochman co-led the study and gave results Saturday at an American Heart Association conference in Philadelphia.

“This study clearly goes against what has been the common wisdom for the last 30, 40 years” and may lead to less testing and invasive treatment for such patients in the future, said Dr. Glenn Levine, a Baylor College of Medicine cardiologist with no role in the research. Some doctors still may quibble with the study, but it was very well done “and I think the results are extremely believable,” he said.

About 17 million Americans have clogged arteries that crimp the heart’s blood supply, which can cause periodic chest pain. Cheap and generic aspirin, cholesterol-lowering drugs and blood pressure medicines are known to cut the risk of a heart attack for these folks, but many doctors also recommend a procedure to improve blood flow.

That’s either a bypass — open-heart surgery to detour around blockages — or angioplasty, in which doctors push a tube through an artery to the clog, inflate a tiny balloon and place a stent, or mesh scaffold, to prop the artery open.

Twelve years ago, a big study found that angioplasty was no better than medicines for preventing heart attacks and deaths in non-emergency heart patients, but many doctors balked at the results and quarreled with the methods.

So the federal government spent $100 million for the new study, which is twice as large, spanned 37 countries and included people with more severe disease — a group most likely to benefit from stents or a bypass.

All 5,179 participants had stress tests, usually done on a treadmill, that suggested blood flow was crimped. All were given lifestyle advice and medicines that improve heart health. Half also were given CT scans to rule out dangerous blockages, then continued on their medicines.

The others were treated as many people with abnormal stress tests are now: They were taken to cardiac catheterization labs for angiograms. The procedure involves placing a tube into a major artery and using special dyes to image the heart’s blood vessels. Blockages were treated right away, with angioplasty in three-fourths of cases and a bypass in the rest.

Doctors then tracked how many in each group suffered a heart attack, heart-related death, cardiac arrest or hospitalization for worsening chest pain or heart failure.

After one year, 7% in the invasively treated group had one of those events versus 5% of those on medicines alone. At four years, the trend reversed — 13% of the procedures group and 15% of the medicines group had suffered a problem. Averaged across the entire study period, the rates were similar regardless of treatment.

If stents and bypasses did not carry risks of their own, “I think the results would have shown an overall benefit” from them, said another study leader, Dr. David Maron of Stanford University. “But that’s not what we found. We found an early harm and later benefit, and they canceled each other out.”

Why might medicines have proved just as effective at reducing risks?

Bypasses and stents fix only a small area. Medicines affect all the arteries, including other spots that might be starting to clog, experts said.

Drugs also have improved a lot in recent years.

Having a procedure did prove better at reducing chest pain, though. Of those who had pain daily or weekly when they entered the study, half in the stent-or-bypass group were free of it within a year versus 20% of those on medicines alone. A placebo effect may have swayed these results — people who know they had a procedure tend to credit it with any improvement they perceive in symptoms.

Dr. Alice Jacobs, a Boston University cardiologist who led a treatment-guidelines panel a few years ago, said any placebo effect fades with time, and people with a lot of chest pain that’s unrelieved by medicines still may want a procedure.

“It’s intuitive that if you take the blockage away you’re going to do better, you’re going to feel better,” but the decision is up to the patient and doctor, she said.

The bottom line: There’s no harm in trying medicines first, especially for people with no or little chest pain, doctors said.

When told they have a problem that can be fixed with a stent, “the grand majority of patients in my experience will opt to undergo that procedure” to get improvement right away, said Dr. Jay Giri, a cardiologist at the University of Pennsylvania with no role in the study.

Maryann Byrnes-Alvarado is not among them. The 66-year-old New York City woman said she joined the study six years ago after having trouble walking, which “scared me to death,” but so did the idea of a heart procedure.

She was relieved when she was assigned to the medication treatment group. Her doctor altered her blood pressure medicine, added a cholesterol drug and aspirin, and adjusted her diet. Now her risk factor numbers are better and she can walk again without difficulty.

“I believe I got the best care that I could get” and avoided an operation, she said.