Exercise As Good As Angioplasty For Some Heart Patients

Better results at half the cost, study finds

MONDAY, March 8, 2004 (HealthDayNews) -- Twenty minutes a day on an exercise bike is better and cheaper than angioplasty in easing the chronic chest pain called angina for people with narrowed heart arteries -- if they have the discipline to choose that alternative, a German study finds.

Cardiologists at the University of Leipzig gave men 70 years and older with stable coronary artery disease a choice between lifestyle changes, including the daily exercise program, or angioplasty, in which a flexible tube called a stent is implanted to maintain blood flow.

"If you ask such patients, about 30 percent are willing to make full lifestyle changes," says Dr. Rainer Hambrecht, a professor of medicine at Leipzig and leader of the group reporting the finding in the March 9 issue of Circulation.

Hambrecht and his colleagues got 101 men who accepted the offer. All had at least a 75 percent narrowing of one artery.

To test the effectiveness of the two approaches, 51 of the men had stents implanted, and the other 50 started an exercise program, spending 20 minutes a day on an exercise bike. The two groups were matched for major heart risk factors including blood cholesterol, blood pressure, smoking history and diabetes.

At the end of a year, 88 percent of the men who completed the exercise program had no heart attacks or other adverse events, while the event-free survival rate for the stented men was 70 percent.

And the exercise program saved money. Chest pain in the participants was graded on a three-class scale. The medical cost of a one-class improvement for men who got stents averaged $6,956, compared to $3,429 for those who exercised.

The benefits have persisted long since the official end of the study, Hambrecht says. "Over two years, and now five years, there has been a very high compliance rate, and the event rate is still significantly different," he says.

As a result, the exercise option is being offered to all patients who meet the study criteria at Lepizig, and the program has been expanded to five centers in Germany and other European centers, with further expansion planned, Hambrecht says.

It's a program that "makes excellent biological sense" for the kind of patients enrolled in the Leipzig program, those with narrowed coronary arteries but no major symptoms other than angina, says Dr. Richard A. Stein, chief of medicine at Beth Israel Medical Center Singer division in New York and a spokesman for the American Heart Association.

"For people with an unstable syndrome, angioplasty is beneficial," Stein says. "But it does not reduce the incidence of heart attacks; it changes them from fatal to nonfatal."

A heart attack happens when a fatty plaque in an artery ruptures, Stein explains, and invading the artery to put in a stent, while beneficial overall, can lead to rupture of a plaque.

Several programs using noninvasive tactics -- combining exercise with cholesterol-lowering drugs, for example -- have gotten good results in patients with stable angina, Stein says.

"But the major challenge is compliance," he says. "Generally, within six months of starting a program, half of the patients are no longer with you. By a year, you settle down to a third."

The Leipzig approach of asking patients to volunteer led to better numbers, Stein says, since "the more you screen people for an initial level of enthusiasm, the more you predict compliance."

But for too many people, he says, the exercise bike "ends up being a good thing to hang clothes on."

More information

The cardiac benefits of exercise and the way to obtain them are explained by the American Heart Association, while the National Heart, Lung, and Blood Institute explains angina.

SOURCES: Rainer Hambrecht, M.D., professor, medicine, University of Leipzig, Germany; Richard A. Stein, M.D., chief, medicine, Beth Israel Medical Center Singer Division, New York City; March 9, 2004, Circulation
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