What is the average additional life expectancy gain by treating angina pectoris?
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What is the average additional life expectancy gain by treating angina pectoris?
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Getting old can be difficult. A good friend of mine has just reached 60 years old and has been very recently diagnosed as having angina. He has chest pain that can be reproduced by
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What is the average additional life expectancy gain by treating angina pectoris?
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What is the average additional life expectancy gain by treating angina pectoris?
posted at 26/6/2012 11:26 PM BST
on bmj.com
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Posts: 339
First: 17/12/2011 Last: 15/5/2013 |
Getting old can be difficult. A good friend of mine has just reached 60 years old and has been very recently diagnosed as having angina. He has chest pain that can be reproduced by exercise. He has a family history of cardiovascular disease. He was previously diagnosed as being hypothyroid and was put on thyroxine about 18months ago. I understand an exercise ecg was 'normal', with no ischaemic changes on the ecg, he is normotensive and has a low cholesterol and is a non smoker. He has been started on I think five medications in addition to the thyroxine he was already taking. I think these medications are, Asprin , a low dose ACE [ramapril], nicorandil, a beta blocker [bisoprolol 2.5mg daily], 40mg of simvastatin and a gtn spray . He is due to have an coronary angiogram soon. He asks me what is the potential gain in life expectancy from taking these medications. He also asks me if he has the angiogram and has a stent, what is the expected gain in years of life from this procedure?
As a simple GP I wish that number needed to treat to do good and number needed to treat to do harm were easily available for medications. I think the expected life gain from these medications might be of the order of between one and five years. When I was a medical student I was taught that Coronary artery surgery might improve symptoms but did not improve mortality. Cardiac stents now seem very common and I suppose that mortality is slightly improved . Can any of the Doc to doc community tell me what average gain in life expectancy from medical and surgical treatment of angina? |
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Re: What is the average additional life expectancy gain by treating angina pectoris?
posted at 27/6/2012 12:18 AM BST
on bmj.com
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Posts: 3031
First: 27/3/2012 Last: 11/5/2013 |
Although many of the studies related to the important topic of discussion did not reveal a significant improvement in life expectancy gain by treating angina, I have a clear minded opinion that the modern advancements in the treatment does improve the life expectancy significantly. The three classical cardiovascular risk factors (cholesterol, smoking, and hypertension) explain almost two-thirds of the decline in CHD mortality. • Limited evidence exists on the potential life-gains following improvements in major population risk factors, as compared to gains from modern cardiology treatments. Twice as many potential life-years can be gained through improvements in the major cardiovascular risk factors compared to gains from modern cardiology treatments. • Cholesterol level reductions in the Irish population achieved almost two-thirds of the overall life-years gained in 2000. • Adverse trends in obesity and diabetes will offset future gains from improvements in the major cardiovascular risk factors. Here are some of the important links: http://eurpub.oxfordjournals.org/content/17/2/193.long http://eurheartj.oxfordjournals.org/content/18/suppl_B/35.full.pdf |
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Re: What is the average additional life expectancy gain by treating angina pectoris?
posted at 27/6/2012 7:38 AM BST
on bmj.com
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Posts: 873
First: 17/6/2011 Last: 17/5/2013 |
There is no life expectancy gain from stenting - there is from surgery if the anatomy is favourable. There is no single outcome trial comparing all modern therapies with none but if you look at the papers that show falling death rates from CHD in the last decade together with the individual papers then it is clear that there is an improvement. I'll dig out the links for you later. sadian |
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Re: What is the average additional life expectancy gain by treating angina pectoris?
posted at 15/8/2012 12:31 PM BST
on bmj.com
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Posts: 339
First: 17/12/2011 Last: 15/5/2013 |
My friend had now had his carotid angiogram and he has significant stenosis in his coronary arteries, I have not seen the diagram he has been given , but he says that he has 90 percent stenosis in one of coronary arteries. He has been advised to have a quadruple bypass rather than any stenting. He is worried that he will died during the bypass operation . His current symptoms are very mild, a little chest discomfort on strenuous exercise. He has a family history of both parents having ischaemic heart disease in their 60s. he is a non smoker , normotensive, regular pulse , low blood cholesterol. He is now taking an ACE [Ramapril] and a statin. I will visit him this weekend. Should I advise him to have the quadruple bypass operation ?. The information I have still says the gain in years of life is small from bypass surgery although it may help symptoms . |
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Re: What is the average additional life expectancy gain by treating angina pectoris?
posted at 15/8/2012 8:08 PM BST
on bmj.com
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Posts: 1784
First: 7/3/2009 Last: 18/5/2013 |
Is the 90% stenosis in LAD? The question is also how those plaques look. Irregular active plaques can cause sudden MI and if the significant narrowing sits in LAD then it can really be bad. |
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Re: What is the average additional life expectancy gain by treating angina pectoris?
posted at 15/8/2012 11:13 PM BST
on bmj.com
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Posts: 873
First: 17/6/2011 Last: 17/5/2013 |
Pat - the mortality benefits come from the grafting of a LIMA to the LAD (particularly if the LAD stenosis is very proximal or the left ventricular ejection fraction is reduced) , or of surgery for extensive CAD including left main stem disease. After that the benefits of treatment are as you say for symptom relief. |
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Re: What is the average additional life expectancy gain by treating angina pectoris?
posted at 16/8/2012 3:14 AM BST
on bmj.com
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Posts: 577
First: 8/6/2011 Last: 18/5/2013 |
1) The logic says that stent or surgery to the patients with angina , who have the indications , improves life expectancy. And only the relief of symptoms will give them a better psychology and activity which will certainly lead in more years of life. ( but i let the continuum to Sadian who of course is better than me on this subjects ) 2) For the majority o people what does matter is the quality of life , so if it is sure that it will be better in the matter of symptoms and only for this it worth to try. 3) Maybe it is better to ask ourselves what life expectancy and quality of life does he has if he don't do the surgery. 4) My personal opinion is that when we are dealing with patients who have a good life expectancy ( as the patient whom you describe ) our treatment strategy need to be aggressive. 5) I think that the overall outcome and life expectancy depends a lot and by the adherence of patient to the medication and life style changes after the surgery or stent 6) it is good to have and tell us the exactly angiogram so what we discuss to be more precise. 7) By the way i have send you a personal message , 3 weeks ago, please check your inbox. |
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