We have opened a new location in Knightdale.Drs. Chow, Gring, and Hook will see patients daily.Grand opening Thursday, April 23, 5-7pm.

Wake Heart has long felt the benefits of cholesterol-lowering drugs, better known as statins, far outway the potential side effects of these drugs in the overwhelming majority of patients in whom they are prescribed. Multiple previous studies have demonstrated a striking reduction in subsequent cardiac events in patients with heart disease.

For the first time, the Jupiter trial evaluated healthy men and women with ”normal” cholesterol levels plus an elevated level of “high-sensitivity C-reactive protein” or hs-CRP — a marker that indicates inflammation in the body.  The study published 11/08 in the NEJM found that statins could significantly reduce their risk of heart disease.  Participants taking Crestor cut their risk of heart attack, stroke and death by nearly half — 44 percent — compared with participants taking the placebo.

Dr. Sachar discusses who should have stress tests performed and answers other common questions about heart disease: http://www.wral.com/lifestyles/healthteam/video/2070620/

Smithfield Heart Associates and Dr. Frank Wefald will separate practices effective Friday, May 30, 2008. Patients wishing to remain with Smithfield Heart will be taken over by Drs. Janis, Atkineson, and Gring. Dr. Wefald can be reached at 919-894-7553.

For patients who meet certain eligibility criteria, carotid stenting offers a less invasive approach than carotid endarterectomy, the traditional surgical treatment for carotid artery blockages. During carotid endarterectomy, an incision is made in the neck at the site of the carotid artery blockage. The artery is isolated and the plaque and diseased portions of the artery are surgically removed. Then, the artery is sewn back together to improve blood flow to the brain. In contrast, carotid stenting can be performed while the patient is awake, reducing recovery time and the risk of complications and re-narrowing.

With carotid stenting, a specially designed guide wire with a filter is placed beyond the site of the narrowing or blockage in the carotid artery. Once the filter is in place, a small balloon catheter is guided to the area of the blockage. When the balloon is inflated, the fatty plaque or blockage is compressed against the artery walls and the diameter of the blood vessel is widened (dilated) to increase blood flow. The balloon is removed and the stent is placed inside the artery to widen the opening and support the artery wall. In 2004, the carotid stenting procedure was approved by the FDA as a treatment option for select patients who have carotid artery stenosis and meet certain criteria. The procedure is approved for patients who are experiencing symptoms, have a carotid artery that is blocked 70 percent or more, and for whom surgery would be highly risky. Research is still ongoing to compare the results of the carotid stenting procedure with that of the carotid endarterectomy surgery. In a 2005 systematic review of five randomized trials comparing the two treatment options, there were no significant differences in major risks of the two treatments.

Wake Heart Associates have been a pioneer in the use of the radial artery for cardiac catheterization and coronary interventions. Reduced access site bleeding complications and the option for immediate ambulation after procedures make this a preferred strategy for many patients. This approach was discussed by Dr. Mann at a conference on July 6, 2007 : http://cathlabconference.dcri.duke.edu/viewarchive.asp

Among patients with stable coronary artery disease, treatment with coronary senting was not associated with a difference in death or MI compared with treatment with medical therapy through 5 years of follow-up.

Despite patients in the study having stable angina, disease severity was relatively intensive, with the majority of patients having multivessel disease and objective evidence of ischemia at study entry. There were no differences in any of the clinical endpoints between the PCI and medical therapy groups, nor was there any treatment interaction with the prespecified subgroups. Freedom from angina occurred slightly more frequently with PCI early in the trial but did not differ between the PCI and medical therapy groups by 5 years, with both arms showing marked reductions in angina throughout the trial.

Findings from the present study apply to stable angina patients and cannot be extrapolated to the acute coronary syndrome population, which has different pathophysiologic characteristics, although the majority of patients currently undergoing PCI are for stable angina. While the majority of the PCI group did not receive drug-eluting stents since most of the enrollment was completed prior to the introduction of these stents, there is no reason to indicate that use of drug-eluting stents would alter the findings of the trial because drug-eluting stents have never been shown to reduce death or MI compared with bare-metal stents in any trial.

The safety and efficacy of drug-eluting stents is now well established, and we feel these are preferred in most patients.  Earlier concerns about their tendency to clot have been answered by several studies demonstrating that this risk is very low if Plavix is taken daily for one year. Reasons not to use these stents include planned elective surgery of any type, increased bleeding risk, and allergy to Plavix. Dr. Chow discusses drug-eluting stents and other aspects of heart disease: http://www.wral.com/lifestyles/healthteam/video/2070652/