Angioplasty and stents offer no advantage over medications alone

Our society has been falsely led to believe that only highly technological interventions and drugs are effective at treating disease. In many cases, however, these interventions merely act as band-aids – temporarily relieving symptoms while the disease process continues to progress.

Heart.  Flickr: Vintage Collective
Percutaneous coronary intervention (PCI), a term that refers to angioplasty and stent placement procedures, is already known to have no advantage over optimal medical therapy (OMT); which refers to modest lifestyle changes plus anti-platelet, blood pressure-lowering, and cholesterol-lowering medications) for reducing heart attack incidence or cardiac mortality. This information made headlines in 2007; the COURAGE trial compared PCI plus OMT to OMT alone, and found no advantage associated with PCI procedures. [1] Since that time, literature reviews have confirmed that PCI did not decrease the rate of heart attack or cardiac death compared to OMT. [2]

Considering that PCI only treats a small portion of a blood vessel, but coronary artery disease affects the entire vasculature, this is not a surprising finding. Because of this finding, the indications for PCI evolved. Now, these interventions are indicated only for the purpose of relieving angina (chest pain caused by restricted blood flow to the heart) symptoms in coronary artery disease patients.

However, a recent review of several clinical trials in patients with stable coronary artery disease has revealed that PCI does not lessen angina any more than medical therapy either. [3] The researchers analyzed human trials that compared either angioplasty or stent placement to OMT with respect to angina symptoms. In 5 clinical trials conducted since 2000, 77% of patients were free of angina after PCI, and 75% of patients were free of angina after OMT, suggesting that PCI does not provide enhanced symptom relief compared to OMT. [4]

We must remember that aggressive interventions like angioplasty and stent placement have serious potential adverse outcomes, such as bleeding complications, heart attack, stroke, and death. [5]  Approximately 25% of angioplasties and 21% of stent placements clog up again (called restenosis) within 6 months, and about 60% of arteries treated by angioplasty will undergo restenosis eventually.[6, 7] These data tell us that PCI is not a long-term solution. Diet and lifestyle changes, however, are long-term solutions because they remove the cause of the heart disease. A low-fat, plant-based diet plus exercise and stress management has been shown to reverse atherosclerotic plaque progression. In addition, 74% of the coronary artery disease patients who had angina and made these lifestyle changes were free of angina after only 12 weeks. [8, 9] This is equivalent to the figures cited above for OMT – except of course, without drugs.

Despite the evidence, cardiologists continue to rationalize that angioplasty and stent placements are essential for their patients. The reality is that modern interventional cardiology should be stopped and medical and nutritional cardiology should be the standard of care. Everyone who has heart disease deserves to know that they have safer, noninvasive alternatives to stents and angioplasty.

In spite of the research we already have documenting the dramatic effectiveness of nutritional interventions [8, 10-12] and the futility of angioplasty and stent placement, this obviously still has not been sufficient to change the practices of conventional cardiologists. There are too many economic forces working against it. Nevertheless, for optimal atherosclerosis reversal and angina relief, my clinical experience with hundreds of patients with advanced heart disease, (confirmed by nutritional intervention studies) demonstrates that optimal nutritional therapy (ONT), with a vegetable-based, high-nutrient (nutritarian) diet – focused on vegetables, beans, fresh fruit, seeds and nuts - is dramatically more effective than PCI or OMT. This approach has already been demonstrated to be more effective than other nutritional interventions at lowering cholesterol; if we compare the published effects of dietary interventions on LDL cholesterol levels, a low-fat plant-based diet reduced LDL by 16%, but a nutritarian diet reduced LDL cholesterol by 33%.[13, 14] This data and my results offer more evidence to suggest that a nutritarian diet is ideal and by including more greens, beans, seeds and nuts leads to even more dramatic results and long-term benefits for heart disease patients.

Of course, larger more definitive studies are needed - exactly one of the initial goals of the Nutritional Research Project. Only with better controlled and documented research results can we foster increased awareness and acceptance of the therapeutic effects of a nutritarian diet for heart disease patients.




1. Boden, W.E., et al., Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med, 2007. 356(15): p. 1503-16.
2. Trikalinos, T.A., et al., Percutaneous coronary interventions for non-acute coronary artery disease: a quantitative 20-year synopsis and a network meta-analysis. Lancet, 2009. 373(9667): p. 911-8.
3. Wijeysundera, H.C., et al., Meta-analysis: effects of percutaneous coronary intervention versus medical therapy on angina relief. Ann Intern Med, 2010. 152(6): p. 370-9.
4. Relief from Angina Symptoms: Percutaneous Coronary Intervention Not a Clear Winner. Journal Watch General Medicine, 2010.
5. Angioplasty and stent placement - heart. MedlinePlus.
6. Agostoni, P., et al., Clinical effectiveness of bare-metal stenting compared with balloon angioplasty in total coronary occlusions: insights from a systematic overview of randomized trials in light of the drug-eluting stent era. Am Heart J, 2006. 151(3): p. 682-9.
7. Hanekamp, C., et al., Randomized comparison of balloon angioplasty versus silicon carbon-coated stent implantation for de novo lesions in small coronary arteries. Am J Cardiol, 2004. 93(10): p. 1233-7.
8. Ornish, D., et al., Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet, 1990. 336(8708): p. 129-33.
9. Frattaroli, J., et al., Angina pectoris and atherosclerotic risk factors in the multisite cardiac lifestyle intervention program. Am J Cardiol, 2008. 101(7): p. 911-8.
10. Esselstyn, C.B., Jr., et al., A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician's practice. J Fam Pract, 1995. 41(6): p. 560-8.
11. Esselstyn, C.B., Jr., Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology). Am J Cardiol, 1999. 84(3): p. 339-41, A8.
12. Ornish, D., Avoiding revascularization with lifestyle changes: The Multicenter Lifestyle Demonstration Project. Am J Cardiol, 1998. 82(10B): p. 72T-76T.
13. Barnard, N.D., et al., Effectiveness of a low-fat vegetarian diet in altering serum lipids in healthy premenopausal women. Am J Cardiol, 2000. 85(8): p. 969-72.
14. Jenkins, D.J., et al., Effect of a very-high-fiber vegetable, fruit, and nut diet on serum lipids and colonic function. Metabolism, 2001. 50(4): p. 494-503.


Angioplasty and Stent Placement is Worthless

In the most recent study, investigators reviewed 61 trials, involving 25,388 patients, in a meta-analysis comparing angioplasty and stent placement with no treatment or medications alone. A meta-analysis pools numerous studies on the same subject. The findings indicated that there was no evidence that angioplasty and stent placement for coronary artery disease resulted in fewer heart attacks or deaths when compared to patients with the same level of disease who were not treated in this manner.

Interventional cardiology and cardiovascular surgery is basically a scam based on a misunderstanding of the nature of heart disease. Searching for and treating obstructive plaque does not address the areas of the coronary vascular tree most likely to rupture and cause heart attacks. If there was never another CABG or angioplasty performed or stent placed, patients with heart disease would be better off. Doctors would be forced to educate our citizens that their heart disease risk is determined by what they place on their forks. Millions of lives would be dramatically extended. To abandon the theory of stretching and cutting out areas with plaque would shut down interventional cardiology, nearly all cardiovascular surgery, and many suppliers of the biotechnology. In many cases, interventional cardiology is the major income generator to hospitals. The ending of this ill-conceived, out-dated and ineffective technology would dramatically downsize hospitals in the United States and free up over $100 billion annually in medical care costs. Besides being ineffective, interventional cardiology places the responsibility in the hands of the doctor and not the patients. When patients finally realize they must take control of their heart problems with aggressive dietary modifications (and when needed medications for temporary periods) we will essentially solve the health crisis in America.

The sad thing is surgical interventions and medications are the foundation of modern cardiology and both are relatively ineffective compared to nutritional excellence. My patients routinely reverse their heart disease, and no longer have vulnerable plaque or high blood pressure, so they do not need medical care, hospitals or cardiologists anymore. The problem is that in the real world cardiac patients are not even informed that heart disease is predictably reversed with nutritional excellence. They are not given the opportunity to choose and just corralled into these surgical interventions.

Trying to figure out how to pay for ineffective and expensive medicine by politicians will never be a real solution. People need to know they do not have to have heart disease to begin with, and if they get it, aggressive nutrition is the most life-saving intervention. And it is free.

Representative Case Studies

The interesting part of the results achieved with excellent nutrition is that lots of these individuals were already on “healthy diets” and getting worse, before following my nutritional protocols to reverse heart disease. Some were even worsening on vegetarian diets. The other notable achievement is they do not get a small amount of reversal of atherosclerosis, they get a dramatic amount of reversal:

  • Case 1: 60 year old male, with chest pain. Height 5’ 8” weight 158. This 60 year old male had read “Fit For Life” over 10 years ago and was following a healthy “starch-based Mediterranean-type diet.” He ate mostly vegetarian foods with brown rice, potato and whole wheat, fruits and vegetables, chicken only a few times a month, fish once or twice a week and some olive oil on salads. He began an exercise program in June of 2006 and surprisingly found he had chest pain with exertion. His weight was stable at 158 for years. A stress thallium test indicated a significant coronary artery disease with an LDL cholesterol of 126. And Lipo (a) of 202. His CT angiogram done on 6/30/06 showed near total obstructive disease in the proximal LAD (left anterior descending artery) due to low density plaque. He began my careful dietary protocol for the reversal of heart disease and did not have angioplasty or bypass as was suggested by the cardiologists. After following my nutritional advice for one month the chest pains resolved and his weight dropped to 140 in the first 8 weeks (loss of 18 pounds). One year later a repeat of the CT angiogram showed the LAD with a non-obstructive mixed density plaque with a stenosis estimated at 50 – 70 percent estimated. His weight has remained around 138 – 140 since following my dietary suggestions. In August of 2008 the last evaluation of his coronary arteries was performed showing normal cardiac blood flow and no evidence of heart disease.
  • Case 2: 44 year old male weight 240 height 5’ 9” high cholesterol. Carotid artery 60 -80 percent as measured by carotid ultrasound. First year after reading Eat To Live and then following the high nutrient protocol he lost 80 pounds. His repeat carotid ultrasound in one year showed no visible plaque.
  • Case 3: Middle age male on the strict version of the Pritikin program for over 3 years while his carotid artery disease as measured by ultrasound, continued to worsen. "After a year on Pritikin, the results were same or very slight improvement. I went on very strict Pritikin for 2 years, to improve it. After 2 years on very strict Pritikin, significantly worse! The radiologist said "The lesion on the left side is stable, there is some early buildup on the right side. I got a nice picture of a lipid (fat) inclusion in the artery wall. I was recommended to Dr. Fuhrman by Jeff Novick, at the Pritikin Center. After 20 months of Fuhrman program, great results. Thinner artery walls. Radiologist comments: "Borderline evidence for evidence of atherosclerotic burden" No longer talking about a lesion or early buildup!! Barely any sign of atherosclerosis. In the 20 months, following my dietary protocol this person, Lost 10 pounds, to pinch 1/2 inch to 6'0" 157 pounds. Last 5 months no snacking, eating 3-4 oz seeds and nuts daily. Ran 2 miles/day, whereas he was running 4 miles/day during the last 2 unsuccessful years on Pritkin. Pritikin was different in that I was living on lots of whole grains, and ate 6+ meals. Much less high nutrient food.
  • Case 4: 66 year old male with a history of Wolfe Parkinson White Syndrome, which was responsible for his sensitivity to develop a rapid heartbeat with the ingestion of caffeine, alcohol and sometimes even heavy exercise. He changed his diet first to vegetarian and then to low fat vegan. After a little more than one year on the very low fat vegan diet his irregular heart beat (arrthymias) worsened and he then developed atrial fibrillation. In June of 2008 he changed his diet to my nutritional recommendation, high micronutrient intake, strict salt avoidance, but not low fat, with the liberal use of nuts and especially seeds and within three months his cardiac arrhythmias completely disappeared. Since then he has religiously kept to this program with no further heart evidence of atrial fibrillation.


Come to your own conclusion.

Image credit: zaveqna