Bandages For the Heart

Chest pain is frightening.  No one wants to face the possibility that their heart is not working properly.

Granted, there are other causes of pain in the chest besides the heart. Symptoms like a sour taste in the mouth; a feeling of food coming back up into the mouth; trouble swallowing; pain that gets better or worse when changing body position; pain that gets worse when breathing deeply or coughing; tenderness when pushing on the chest; or pain that continues for many hours or days can indicate a different origin.  However, the pain may be coming from the coronary arteries that supply oxygen to the heart, a more ominous circumstance. Heart pain usually starts as angina, a feeling of pressure, heaviness or tightness in the chest caused by reduced blood flow to the heart and the resulting reduction of the oxygen required to maintain the heart’s function.  Heart pain can also announce the onset of a heart attack in which the flow of blood in an artery that supplies the heart is blocked, a life-threatening emergency situation. (1)

What happens when the coronary arteries start to narrow? The process is known as atherosclerosis. It is caused by a cascade of events in which factors like high LDL-cholesterol and triglyceride levels, high blood pressure, obesity, diabetes, an unhealthy diet, smoking, and/or a sedentary lifestyle can play a role in damaging the inner layers of blood vessels. The injury in the artery wall allows substances such as LDL-cholesterol to accumulate within the vessel wall. Once there, they become oxidized triggering an inflammatory response.  White blood cells, part of the immune system, rush to the injured area and attempt to remove the oxidized LDL. Inevitably they become engorged and transform into “foam cells”, the first visible sign of plaque.  This lesion continues to grow. The body tries to wall off the plaque by forming a protective cover using smooth muscle cells from the artery’s middle layer along with proteins and collagen. What results is a plaque consisting of a lipid core, dead cells, calcium deposits and an overlying fibrous cap. Plaques slowly increase in size, causing progressive narrowing of the artery and the gradual onset of angina.  If a plaque ruptures, clot formation can cause a total blockage of a coronary artery leading to a heart attack. (2)

 

The Evolution of Heart Treatment Options

Over the last few decades, our medical system has developed a range of treatments for heart pain. Angioplasty came first with the earliest balloon angioplasty performed in a human in 1977. Angioplasty involves a surgical procedure in which a small incision is made in a blood vessel in the groin or wrist through which a thin, flexible catheter is threaded up to the damaged area of a heart blood vessel.  Once there, a tiny medical balloon on the end of the catheter is inflated to push the blockage off to the side of the artery wall out of the way. This relieves the narrowing or blockage in a coronary blood vessel which has been reducing the supply of blood to the heart. (3,4)

In the early days of angioplasty, re-narrowing (restenosis) of the treated blood vessel was a frequent cause of failure. At that time, there was a 40% chance of restenosis within the first six months following the procedure. There are a couple of reasons for this. Firstly, arteries are elastic and can “recoil” within hours or days after the procedure, leading to restenosis and rapid recurrence of symptoms like angina.  Also, the procedure itself can inflict trauma to the artery wall which, during healing, can initiate the process of scarring and artery narrowing. (5)

Improvements in angioplasty during the 1980s led to the introduction of stents, small tubes made of metal mesh which serve as “scaffolds” to keep blood vessel walls dilated and reduce the risk of restenosis. This procedure is called PCI (Percutaneous Coronary Intervention), aka “coronary angioplasty with stenting”.  The use of stents lowered the chance of restenosis to 20 to 30%. (5,6)

Stents were further improved in the early 2000s when they became “drug-eluting stents”. This involves the coating of a metal stent with medication that will help prevent scar tissue from forming. The medication is designed to release gradually into the arterial wall over the first few months after the surgery. Drug-eluting stents reduce the risk of restenosis of the artery to about 15%. (4,5)

The mechanisms behind restenosis are not completely understood. After angioplasty and stenting, smooth muscle cells grow over the area to form a new lining for the artery wall that allows the blood to flow easily and prevents the formation of a blood clot.  Scar tissue can also form during the healing process.  It is thought that an inflammatory reaction increases the growth of tissue on and around the stent, ultimately causing the re-narrowing of the artery.  In-stent restenosis typically occurs within three to six months after treatment. When symptoms occur, they are often similar to those of the original coronary artery disease.  Factors such as high cholesterol levels, kidney disease, smoking, poor diet and uncontrolled high blood pressure and/or diabetes can increase the risk of restenosis.  Stenting is being continually improved but it still comes with risks. (5,7)

Coronary artery bypass surgery is another treatment available for reducing heart pain and artery narrowing. It has evolved from early experiments in the 1960s to its use today as the “gold standard” treatment of disease when multiple arteries are damaged or if it is the left main coronary artery that is affected. (8)  Coronary artery bypass surgery entails creating a new pathway for the blood to take, sending it around a blocked or partially blocked artery. This requires the removal of a healthy blood vessel from the chest or leg area and connecting it to the diseased blood vessel below the blockage. Restenosis is a significant long-term complication of coronary bypass surgery too, affecting up to 20% of cases.  (9)

Large, randomized trials comparing coronary bypass surgery with the placement of stents have found that for most people the results are similar in terms of future risks. A multi-national study in March 2025 showed that the risks of death and stroke were much the same whether patients received bypass surgery or stenting, although the risk of heart attack was slightly higher after stenting and stents were more likely to require a repeat procedure.  Authors of this research stated that their results reflect the ongoing advances in medical technology and practices.

Hospitals generally use a “heart team” approach when deciding on the best treatment for a patient and both a cardiologist and a cardiac surgeon will consider the severity of the disease, the patient’s history and overall health, and the potential risks associated with each procedure. (8,10)

 

Risks of Heart Treatments

Angioplasty with stenting and coronary bypass surgery are generally safe procedures. However, they do have risks.

Risks of angioplasty with stenting include (6,11)…

• Bleeding or infection at the site of the catheter insertion
• Injury to the heart arteries
• Blood clots that can lead to stroke or heart attack
• Re-narrowing of the artery (restenosis)
• Allergic reaction or kidney damage from the dye or the contrast material used in X-rays
• Death

Risks of coronary artery bypass surgery include the above risks plus (12,26)…

• Infection at the site of the chest wound
• Long-term need for a breathing machine
• Irregular heartbeats (arrhythmias)
• Kidney disease
• Memory loss or trouble thinking clearly, often a temporary effect

 

 

To Use or Not to Use a Heart Treatment

For people who are suffering a heart attack, the placement of a stent can be life saving.  However, many stents are put into place to ease chest pains caused by reduced flow of blood to the heart due to narrowed blood vessels. The American Heart Association and the American College of Cardiology do not recommend stents for all people who have chest pain. Physicians are advised to evaluate the risks of each patient and to start treatment with medications that help to control cholesterol and blood pressure. If symptoms continue or if an artery is 70% blocked or more, placing a stent would then be considered. (13)

In 2017 the ORBITA trial added to the current information regarding whether or not to use a stent. This blinded, randomized trial compared the health results after placement of a stent with those in participants who did not receive a stent.  All two hundred participants included in this study showed stable chest pain (angina) due to a blockage of more than 70% in a single coronary artery. For six weeks before surgery, all participants received standard medications for reducing the symptoms of chest pain and lowering the risk of the formation of blood clots. Then, all participants underwent the surgery for a stent but only half of them actually received one. The other half experienced the same surgery, but no stent was placed. Six weeks after the surgery, the heart function of all participants was analysed through a battery of cardiopulmonary tests. Participants also filled out a self-report covering their own mobility, activity levels, pain or discomfort, and anxiety or depression. Surprisingly, there was no statistical difference in major heart events between the group who had received a stent and the group that did not. Placing a stent did not result in better outcomes for patients in the risk of death, myocardial infarction or other major cardiovascular events. (14)

In 2020 the ISCHEMIA study provided another comparison of heart treatments. This research included 5,170 patients from around the world who received either medications to control blood pressure, cholesterol, and angina along with counseling about diet and exercise, or the above steps with the addition of surgery.  Most participants had a history of chest pain, with 21% reporting daily or weekly chest pain and about 35% reporting no chest pain one month prior to enrollment in this trial.  Over the five years of this investigation, 21% of patients in the medical therapy/lifestyle changes group received a stent or bypass surgery while the rest continued on medication alone. In the medical therapy/lifestyle changes/surgery group, 79% of the participants received a stent and the rest underwent bypass surgery. At the end of the trial, the rate of death between the two groups was essentially equal. This study concluded that invasive procedures like bypass surgery and stenting are no better than medication and lifestyle changes in diet and exercise habits for reducing the risk of heart attack and death in people with severe but stable coronary heart disease. However, in those suffering daily or weekly angina chest pain, these invasive procedures can provide symptom relief and improve quality of life. The study’s lead author and principal investigator, David Maron, M.D. director of the Stanford Prevention Research Center, stated, “Taken together, the quality of life and clinical results suggest that there is no need for invasive procedures in patients without symptoms. For those with angina, our results show it is just as safe to begin treating with medication and lifestyle change, and then if symptoms persist, discuss invasive treatment options.” (15)

It must be repeated that, in the emergency situation of someone actively experiencing a heart attack, invasive heart treatments can be lifesaving. But, in patients with stable angina, they appear to treat only the symptoms, not the cause of the underlying disease.

Many heart patients do not understand this.  After their heart surgery they feel that their heart disease has been cured.  In reality, a stent or a bypass only fixes one blockage, and the fix may not last very long. Heart disease affects the whole circulatory system. Without lifestyle changes, narrowing of arteries will continue to develop in both untreated and treated arteries.  Studies from the American Heart Association reveal that about 1 in 5 patients experience restenosis of a treated artery within just 6 to 12 months, especially if healthier lifestyle habits have not been adopted.  Heart disease will continue to progress unless preventative steps are taken. (16)

 

 

Living a Heart-Healthy Life

Medical research has shown that it is indeed possible to reverse heart disease.  A 2014 trial of 198 patients agreed to transition to a plant-based diet, eliminating dairy, fish, meat and added oil.  They received intensive counselling along with their usual cardiovascular care.  Results showed that 177 of the 198 patients adhered to their new eating pattern for an average of 3.7 years and only one of these adherent patients experienced a cardiac event (a 0.6% risk),  in this case, a stroke.  Thirteen of the 21non-adherent participants experienced an adverse event (a 62% risk).  The researchers also documented the disappearance of some plaque and the opening up of arteries resulting in improvement of blood flow to the heart.  (17)

An analysis from 2018 explored the effects of physical activity on heart health and found that regular exercise lowers the incidence of cardiovascular disease.  This result was attributed to the increase in the health of the endothelium through exercising.  The endothelium is the thin inner lining of blood vessels which plays a crucial role in regulating blood flow and maintaining vascular health. Dysfunction of the endothelium is the first step towards atherosclerosis, the build-up of plaque within arteries. Even after cardiovascular disease has developed, regular exercise can benefit the heart by slowing its progression. Patients who have received a stent also benefit from exercise with increases in oxygen uptake by 26%, improvements in quality of life by 27% and a 20% reduction in cardiac events like a heart attack or onset of unstable angina.  (18)

So it is becoming clear that the long-term outcome of all these heart treatments depends on how well you take care of your health after your procedure.  (19)

There are many ways to improve heart health.  The following are some suggested steps that you can adopt into your own life to increase the health of your heart. (20,21,22,23,24,25,12)

 

DIET:

Eat an overall healthy dietary pattern that emphasizes…

• Consuming a wide variety of fruits and vegetables. They are low in calories, high in vitamins, minerals, antioxidants and phytonutrients and very rich in fiber.  Whole colourful foods are especially beneficial due to their natural content of phytonutrients which are not essential for survival but have antioxidant and anti-inflammatory properties.  Keep in mind that frozen fruits and vegetables can be another healthy source.          Aim for 5 to 7 servings a day
• Choosing whole grains and products made from whole grains. They are another great source of fiber, play a role in controlling blood pressure, and lower the risk of heart disease and diabetes. Look for brown rice, wild rice, flaked oats, quinoa, whole wheat, barley, rye and millet along with whole-grain breads and pastas.  Check labels and try to choose healthy bread products that contain at least 1 gram of dietary fiber for every 5 grams of carbohydrates in the product.  Aim for 3 to 4 servings a day
• Limiting saturated fats and trans-fats. This can help to lower your blood cholesterol which reduces the build-up of plaque in arteries.  The American Heart Association recommends keeping saturated fat to less than 6% of total daily calories and to avoid trans-fats altogether.
• Using oils sparingly. Stay away from tropical oils (coconut oil, palm oil and palm kernel oil) and deep-fried foods.  If you use oil, choose from healthier ones like canola oil and olive oil.
• Eating healthy sources of protein such as plant protein from legumes, nuts, tofu, and tempeh. If you are still eating animal-sourced foods, eat minimal amounts of fatty fish (mackerel, salmon, herring or sardines) and low-fat dairy. Avoid red meats.
• Eating nuts – Consuming a handful a day (about 1 ounce or 28 grams) of unsalted nuts such as peanuts, almonds, walnuts, pistachios, cashews or Brazil nuts has been linked to a 20% reduction in heart disease and risk of death from heart disease and a 10% reduction in cancer deaths when compared with not eating nuts.
• Eating seeds – Incorporate healthy seeds into your diet like chia seeds, flax seeds, hemp seeds, pumpkin seeds, sunflower seeds and sesame seeds. Flaxseeds, chia seeds and hemp seeds can be easily added to smoothies, salads and stews.  Pumpkin and sunflower seeds enhance morning porridges or cereal.  Sesame seeds are a great addition to soups or stews.  Most hummus is based  on sesame seeds but be sure to check labels for the full list of ingredients.
• Making your beverage of choice plain water. Other healthy drink choices are tea (green, black or herbal), black coffee, and water flavoured with a few drops of unsweetened flavouring such as lemon or lime juice.

Reduce sodium and salt.  Keep sodium intake under 2300 mg per day (about 1 teaspoon of table salt) and avoid highly processed foods which often contain very high levels of sodium.

 Limit processed food. Many of them contain excessive levels of sugar, oil and salt.  Concentrate on eating whole foods as much as possible.  Some minimally processed foods are healthy including products  like frozen fruits and vegetables; canned fruits and vegetables (check for salt content); peanut butter with no added oils, salt or sugar;  and plant-sourced milks.  Limit foods with many additives like preservatives, oil, sugar, salt, colouring and flavouring.

Keep added sugar low.  Aim for sugar levels of less than 10% of your daily calorie intake.  Avoid sweets, baked desserts, processed desserts and sugary soda drinks.

Limit alcohol intake to 2 drinks a week or, now recognized as best for your health, eliminate alcohol from your life.

 

 

EXERCISE:

Physical activity strengthens your heart, improves circulation, lowers blood pressure, helps control weight, reduces stress and lowers the likelihood of future cardiac problems.

Aim for at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity each week.

Ideally, your activity should be spread throughout the week.  For example, exercise for 30 minutes on 5 days of the week.

After stent placement or bypass surgery, be sure to follow your recommended cardiac rehab program from your heart doctor.  It can start you on a new path of moving your body that offers benefits both to your heart and to your whole body that can be enjoyed for the rest of your life.

Manage stress.  Chronic stress is detrimental to the heart and increases cardiac risk.  Techniques like mindfulness, deep breathing, meditation and yoga can help to relieve stress. Nurture your social connections.  Spend time with family and friends.

Stop smoking.  It is a major risk factor for developing coronary artery disease and contributes to plaque buildup in the arteries, damage to blood vessels and the reduction of oxygen levels in your blood. Quitting smoking can decrease the risk of blood clots and heart attacks by more than 50%.

Maintain a healthy weight.  Increased BMI is a significant risk factor for future heart problems.

Get adequate sleep.  Follow good pre-sleep practices and aim to get 7 to 8 hours of sleep nightly.

Keep blood pressure within a healthy range.  High blood pressure increases the strain on the heart, arteries and kidneys.

Keep diabetes under control.  Diabetes and pre-diabetes are well-known risk factors for future cardiac events and restenosis.  Improving glucose regulation through diet and exercise can significantly reduce risks for the heart.

 

 

SOURCES:

1   https://www.mayoclinic.org/diseases-conditions/chest-pain/symptoms-causes/syc-20370838

2 https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342017/all/Coronary_Heart_Disease%C2%A0

3  https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/in-depth/drug-eluting-stents/art-20044911

4  Simard, T., Hibbert, B., Ramirez, D., Froeschl, M., Chen, Y.-X., O’Brien, E.R.  The Evolution of Coronary Stents: A Brief Review; Canadian Journal of Cardiology 2014; 30 (2014) 35e45

5  https://icardio.ca/en/coronary-restenosis-post-angioplasty/

6  https://my.clevelandclinic.org/health/treatments/22066-percutaneous-coronary-intervention

7  https://my.clevelandclinic.org/health/diseases/17132-cad-in-stent-restenosis

8  Melly, L., Torregrossa, G., Lee, T., Jansens, J.L., Puskas, J.D. Fifty years of coronary artery bypass grafting. J Thorac Dis. 2018 Mar;10(3):1960-1967. Doi: 10.21037/jtd.2018.02.43. PMID: 29707352; PMCID: PMC5906252.

9   Yaqin, M.A., Murtadho, F.A.  Decoding Restenosis Risk After CABG: A Combined Transcriptomic and Mendelian Randomization Analysis.  Doi:https://doi.org/10.1101/2025.08.06.25333136.

10  https://www.health.harvard.edu/heart-health/why-choose-bypass-surgery-over-stents

11  https://stanfordhealthcare.org/medical-treatments/p/percutaneous-coronary-revascularization/risks.html

12   https://www.nhlbi.nih.gov/health/heart/smoking/benefits-to-quit

13  https://time.com/5009249/do-heart-stents-work/

14 Al-Lamee, R., Thompson, D., Dehbi,  A.-M., Sen, S., Tang, K., Davies, J., et al.  Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial.  The Lancet 2017;1:391; Issue 10115, 31 – 40.

15  https://www.nhlbi.nih.gov/news/2020/stents-and-surgery-no-better-less-invasive-measures-reducing-heart-attack-stable-ischemic

16 https://www.ahajournals.org/doi/pdf/10.1161/01.CIR.0000019122.00032.DF

17  Esselstyn, C.B. Jr, Gendy, G., Doyle, J., Golubic, M., Roizen, M.F. A way to reverse CAD? J Fam Pract. 2014 Jul;63(7):356-364b. PMID: 25198208.

18  Winzer, E.B., Woitek, F., Linke, A. Physical Activity in the Prevention and Treatment of Coronary Artery Disease. J Am Heart Assoc. 2018 Feb 8;7(4):e007725. doi: 10.1161/JAHA.117.007725. PMID: 29437600; PMCID: PMC5850195.

19  https://www.mayoclinic.org/tests-procedures/coronary-bypass-surgery/about/pac-20384589

20  https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-healthy-diet/art-20047702

21  https://www.nhs.uk/conditions/coronary-heart-disease/prevention/

22  https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/aha-diet-and-lifestyle-recommendations

23  https://www.scvc.co.uk/naked-heart/10-things-everyone-who-has-had-a-coronary-stent-or-bypass-operation-should-know/

24  https://www.ccsa.ca/en/guidance-tools-resources/substance-use-and-addiction/alcohol/canadas-guidance-alcohol-and-health

25  Balakrishna, R., Bjørnerud, T., Bemanian, M., Aune, D., Fadnes, L.T. Consumption of nuts and seeds and health outcomes Including cardiovascular disease, diabetes and metabolic disease, cancer, and mortality: an umbrella review. Adv Nutr. 2022;13(6):2136-2148. Doi:10.1093/advances/nmac077

26  https://www.mayoclinic.org/tests-procedures/coronary-bypass-surgery/about/pac-20384589