Dr. Roach: Should heart patient receive stent or not?

Dear Dr. Roach: My regular cardiologist did a battery of screening tests. Sure enough, one of the tests suggested blockages, and he said I should prepare to get an angiogram from an interventionalist to verify and possibly have stent(s) placed. My heart muscle still has no damage (I had quadruple bypass six years ago, even though I had no symptoms; I am 68, not overweight and have never smoked). Since receiving the news five weeks ago about possible blockages, I have exercised, eaten very well and have seen my blood pressure go back to normal and my lipid panel all come within normal range.

When I asked my regular cardiologist if having stents placed would prevent me from having a heart attack, he gave a resounding “yes,” it would. I have read that stents do not prevent heart attacks and are effective only if you have angina (I don’t) or are having a heart attack (I’m not). My older brother had stents placed, and they caused him so much trouble that they had to remove them. What is your take?

J.T.

Dear J.T.: The answer comes from the medical literature and it contradicts what your regular cardiologist told you. Opening blood vessels, and keeping them open with stents, in combination with optimal medical management, relieves symptoms better but does not significantly decrease heart attacks and death rates compared with optimal medical management alone. There is an exception, as you identified: In an acute heart attack, stenting open the blocked blood vessel does decrease the rate of cardiac mortality.

Any medical procedure can have untoward effects, and with stents, the biggest one is the stent closing (due to blood clots). I have never heard of cardiac stents being removed, since the innermost wall of the artery tends to grow around the stent, making removal dangerous or impossible except through surgery. I think your lifestyle changes of diet and exercise, along with your medical therapy, is doing you more good than stents would.

Dear Roach: I read that during the flu pandemic of the early 1920s, a doctor took alcohol baths for protection. I presume he swabbed his body with rubbing alcohol. Does it make sense to do this now?

R.O.

Dear R.O.: Bathing in alcohol or swabbing the body with it isn’t a good preventive for anything, including the flu. People spread the flu virus by coughing or sneezing airborne droplets containing it or transferring it with virus-covered fingers and hands. Frequent hand-washing with soap and water is a better way to protect yourself. Alcohol hand wipes also cut the chance of transmission. Getting the flu shot is the best way to stay free of the flu.

Email questions to ToYourGoodHealth@med.cornell.edu.