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 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.


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Comments (7) Read through and enter the discussion with the form at the end
MIke Rubino - December 17, 2010 5:50 PM

They dont want to follow the studies because they know no other method of treatment and they therefore would then be out of business.I really feel lucky that a stent was not placed in me and due to my close call with having one put in I dont trust cardiologists and the more I read things like this the more I consider them nothing but Hi Tech Voo Doo doctors.

I feel lucky to have found DR F and ETL and I am confident in the truth of the last paragraph . Further I feel sure that I have been better served with the ETL diet than if a stent was installed and having then followed an AHA type diet.

Gerry - December 17, 2010 6:47 PM

Another excellent article by Dr. Fuhrman.

I support and applaud what you do in this area, not only in the practice you provide, the books which you have written, the website and newsletters you started and sponsor (they saved my life) but also in the newly instituted research project you have begun.

I was wondering if you had considered a sister project designed to actively campaign for legal reform of the "standard of care" you so well identify as out of step with reality, and economically driven? Such a group might engage in law suits to pressure Medicare to cease funding wasteful tax dollars on such proceedures, and similarly to sue the government for subsidizing big Agricultural practices that foster the poor eating habits that Americans are paying for not only with their poor health, but with a broken, and broke health care system.

I realize this is a "radical" suggestion, and is a great effort, but I believe we are at a point where radical actions are called for, and there would be, I believe, if accompanied by broad based educational efforts, much of which are starting and/or in progress already, a greater acceptance to these methods than many think.

Such efforts themselves serve to bring broad attention to this subject and thus themselves are educational in their own rite, much as the legal actions against the tobacco companies were. And we know what eventually happened there, and so this battle is winnable. It just takes information, effort and money, and time. The alternative is death: physical, financial, and yes,'s that pervasive a problem.

Just a few thoughts.

Once again, thank you for all you do and have done to bring truth, reality, and health to the world of proper eating habits!

In Him,

Wendy Solganik - December 17, 2010 7:59 PM

Almost a year ago I attended a lecture of Dr. Esselstyn's in Cleveland, Ohio. Prior to my hearing Dr. Esselstyn, I had read Eat to Live and was becoming more and more of a Nutritarian. But it was hearing Dr. Esselstyn present the evidence in a live format that just put me over the edge. I became almost 100% no-added-fat vegan from that day forward.

Dr. Esselstyn gave the same lecture last night and I encouraged all of my friends and loved ones to attend. CNN was there taping the lecture. It's great to see that this information is getting more and more attention!

Karen - December 17, 2010 11:36 PM

Just today, I mentioned to a cardiologist in the elevator at the hospital where I work that a friend (who had PCI) told me he is going off his medications because of the success of his plant-based diet. The cardiologist then proceeded to tell me that my friend shouldn't go off his medications, that the medications work very well! I wish I had had this article to hand to him.

john polifronio - December 18, 2010 4:35 AM

I must be an exception. I developed an unstable angina condtion at age 55, was hospitalized in severe pain, refused strongly recommended surgery at that time, and was finally released. I subsequently commenced an Ornish diet, to which I adhered 99%, for 4 years. The result was, that, though I survive to this day, probably due to fairly extensive collateral circulation, there was, as far as I could tell, not an iota of pain diminution. Though I have suffered immensely over, roughly, 17 yrs, I have yet to permit surgery. I'm 72 years of age. If I have any remaining time in this world, I still hold out the vauge and distant hope that it'll be free of angina, though I seriously doubt this will likely happen without the surgery that my cardiologist has long ago given up trying to persuade me to engage in. Any thoughts?

MIke Rubino - December 18, 2010 10:40 AM

John, Call Dr F, many of us think his diet far superior to the Ornish plan.

Deana Ferreri, Ph.D. - December 19, 2010 12:20 PM


An “Ornish” diet, or any other program is NOT the same as Dr. Fuhrman’s “nutritarian” recommendations for heart disease reversal. If you are still having symptoms you should join the membership at and have Dr. Fuhrman advise you directly on how to tweak your diet for maximal reversal. You are an “exception” only because you not getting adequate or ideal advice. Another option is for you to call the office and set up a phone consult or visit with Dr. Fuhrman or Dr. Benson.

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