Dr Ford Brewer - PrevMed I Was Wrong About Stents - Ford Brewer MD MPH
Sep 16, 2024
Explore the shifting perspectives on heart disease risk and the controversial use of stents. Hear about advanced diagnostic techniques that reveal the nuances of vulnerable plaque in arteries. Learn about misleading nutritional claims that fuel health myths, and the complex relationship between dietary habits and heart health. Dive into the debate on stent efficacy, especially regarding their long-term benefits versus lifestyle changes. Uncover the differences between plaque types and the importance of informed health choices for better patient outcomes.
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PREVENT Trial Design Overview
- PREVENT randomized ~1,600 patients with non-flow-limiting soft plaque to stent plus therapy vs therapy alone.
- The trial tested whether prophylactic stenting of vulnerable plaques reduces cardiac events.
Two-Year Outcome Difference Was Small But Significant
- At two years the composite endpoint occurred in 0.4% stent vs 3.4% medical group, a significant relative difference.
- Statistical power looked solid, but baseline differences can affect interpretation.
High NNT Shows Modest Absolute Benefit
- Number-needed-to-treat (NNT) was high: about 45 to prevent one event and ~88 to prevent one cardiac death over two years.
- High NNT highlights modest absolute benefit despite statistical significance.