The date is set. 9/29/19

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Heart to Heart; Stents

Maybe they’re not so good after all.

From the NY Times,

THE NEW HEALTH CARE

Heart Stents Are Useless for Most Stable Patients. They’re Still Widely Used.
Why are so many people agreeing to an expensive procedure — and putting themselves at risk — for a placebo effect?

Aaron E. Carroll
By Aaron E. Carroll
Feb. 12, 2018

From the New England Journal of Medicine

Optimal Medical Therapy with or without PCI for Stable Coronary Disease

William E. Boden, M.D., Robert A. O’Rourke, M.D., Koon K. Teo, M.B., B.Ch., Ph.D., Pamela M. Hartigan, Ph.D., David J. Maron, M.D., William J. Kostuk, M.D., Merril Knudtson, M.D., Marcin Dada, M.D., Paul Casperson, Ph.D., Crystal L. Harris, Pharm.D., Bernard R. Chaitman, M.D., Leslee Shaw, Ph.D., et al., for the COURAGE Trial Research Group*

CONCLUSIONS
As an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy. (ClinicalTrials.gov number, NCT00007657.)

From JAMA: The Journal of the American Medical Association

Review Article
Feb 27, 2012

Initial Coronary Stent Implantation With Medical Therapy vs Medical Therapy Alone for Stable Coronary Artery DiseaseMeta-analysis of Randomized Controlled Trials

Arch Intern Med. 2012;172(4):312-319. doi:10.1001/archinternmed.2011.1484
Conclusion Initial stent implantation for stable CAD shows no evidence of benefit compared with initial medical therapy for prevention of death, nonfatal MI, unplanned revascularization, or angina.

 

The Tragedy of Muddy Trails

I understand you work hard all week long and you only have so much time to ride.

I can understand volunteering on the trails is not your thing.

I can understand you don’t want to donate to the organizations the build and maintain trails.

But I can’t understand why you go out of your way to fuck up trails.

The ruts you leave will screw up the trails for every other rider until a volunteer gets around to fixing it.

Don’t be a dick, hit the trainer, ride the road, just stay off the trails when they’re soft and muddy.