Which drugs are the right ones for heart problems, and who really needs them? When are heart tests needed, and when are they not only unnecessary, but possibly harmful? Are drugs or stents better? And, when surgery is required, how do you find the best hospital?
Figuring out what to do about heart problems is complicated. To address the issue, Consumer Reports offers a report on how to help consumers make smart choices about the prevention and treatment of heart disease.
The dangers of too many screening tests
Too many heart tests can lead to a series of false alarms that trigger needless anxiety and a cascade of costly, sometimes risky procedures, according to the report. If you feel fine and are at low risk, before you agree to a test, ask why it’s necessary.
“If you don’t get a satisfactory answer, politely decline it or ask for a second opinion,” said Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser.
Here’s information about common tests that are often incorrectly used in low-risk people, according to Consumer Reports:
- Electrocardiogram – EKG or ECG: May be useful for people with symptoms of heart disease such as chest pain, and possibly for those at risk of heart disease who are starting to exercise.
- Exercise stress test: May be useful when combined with an EKG or in people with an abnormal EKG.
- Abdominal aortic aneurysm test: May be useful for people with detectable lumps in the abdomen and men 65 to 75, especially those who have smoked. Women 65 and older who smoked might consider it, though evidence is less certain.
- Peripheral artery disease test: May be useful for people with cramping in their hips, thighs, or calves when walking or exercising.
- Carotid artery imaging: May be useful for people who have had a stroke or ministroke.
- CT angiography: May be useful for people with chest pain and unclear results on an EKG and stress test.
Who really needs heart drugs: Guiding consumers through the maze
Many medical professionals agree that high blood pressure and high cholesterol increase the risk of heart attack and stroke, but they don’t agree on when you should take drugs. Consumer Reports’ Best Buy Drugs suggests the following to help guide and inform decision-making:
- Focus on your overall risk. Everyone 40 and older should know their 10-year risk of having a heart attack or stroke. The ideal is a 10-year risk that’s less than 7.5 percent. To determine your risk, Consumer Reports suggests using a calculator developed by the American College of Cardiology and the American Heart Association, at tools.acc.org/ASCVD-Risk-Estimator. http://tools.acc.org/ascvd-risk-estimator/
- Don’t rush to drugs. If your blood pressure and cholesterol numbers are slightly elevated, consider with your doctor that lifestyle measures should be embraced first, before starting statin drugs. For example, Consumer Reports points out that regular exercise can lower your systolic pressure – that’s the upper number – by up to 9 points.
- Get the right medication. When a statin or blood pressure drug is necessary, Consumer Reports said that it usually makes sense to start with the oldest, safest, and least expensive drug. For high blood pressure, Consumer Reports Best Buy Drugs recommends diuretics, or water pills, such as chlorthalidone or hydrochlorothiazide. If that doesn’t work, you may need to switch to or add an ACE inhibitor, calcium channel blocker, or other kind of drug. To prevent a first heart attack or stroke, low doses of statin drugs like lovastatin, pravastatin, or simvastatin can be beneficial. Go to org for more details on high blood pressure and statin drugs.
Choosing the right hospital
In some cases, heart disease is so serious that drugs, even when combined with other interventions, such as angioplasty, may not be enough. In that case, you probably need surgery either to bypass blood flow around blockages in your coronary arteries or to correct a malfunctioning heart valve. And while both of these problems are serious, they aren’t always emergencies. Your doctor can often stabilize your condition with drugs, giving you the opportunity and time to consider your options, according to the report.
“People will often do a better job comparison shopping with a car they might buy than the heart program they go to,” said Steven Nissen, M.D., chairman of the department of cardiovascular medicine at the Cleveland Clinic Foundation.
Consumer Reports is offering updated ratings of nearly 500 hospitals on coronary artery bypass surgery and aortic valve replacement surgery.
“We’ve made solid progress engaging more hospitals to share their data with Consumer Reports, but still only about half of the hospitals that do heart surgery are willing to be transparent with their results,” said Doris Peter, Ph.D., director of the Consumer Reports’ Health Ratings Center. “We want all hospitals to share their surgical results because we believe – and research has shown – that that kind of transparency leads to improvement.”
Which hospital you choose for your heart surgery matters, said Peter. A list of hospitals rated by Consumer Reports, in partnership with The Society of Thoracic Surgeons, can be found at www.cr.org/hearthospitals0517.
Of the hospitals rated, only 20 hospitals earned top scores in both heart bypass and aortic valve replacement surgery. If the hospital you’re considering isn’t listed, Consumer Reports suggests asking your surgeon how it performs on the STS measures.
“If your surgeon won’t share that information with you, or can’t share that information, we suggest you keep looking,” said Peter.
Consumer Reports’ healthy heart report appears in the May issue of its magazine and online at CR.org.