The number of deaths from heart disease reads like a terrifying roll call of modern times: in 1989, 1 million people died of heart disease in the US, and a further 160,000 in the UK.

The saddest element of an already tragic situation is that of the 1.5m people who suffer a heart attack in the US each year, just 350,000 live to tell the tale. In other words, the first heart attack is often the last.

Not surprisingly, medical research places great emphasis on understanding the causes, but to little effect. One study concluded that bald men are more likely to suffer from a heart attack than their hirsute colleagues (the fact that bald men tend to be older doesn't seem to have occurred to the researchers).

Virtually every week a piece of research is published, often offering contrary findings to a previous paper. Indeed, a recent paper reckoned that all the standard causes smoking, high blood pressure and cholesterol accounted for no more than 50 per cent of total risks (JAMA, 24 February 1993).

Even so, the death rate from heart disease fell by 30 per cent between 1979 and 1989 and, again, researchers don't seem to have an explanation, save that perhaps people are smoking less.

But despite all this uncertainty, one procedure coronary balloon angioplasty, or percutaneous transluminal coronary angioplasty (PTCA), to give it its proper name has come through as the major method of treating heart problems, particularly angina.

In this article, we explore the benefits and risks of the procedure, as well as other conventional practices, and the main alternative treatment, chelation therapy, and the latest theories about reducing the risks of developing a heart condition in the first place.

If you are one of the "lucky minority" to be diagnosed with a heart condition before suffering a fatal attack usually because of severe pains, breathlessness or difficulty in walking the chances are that your doctor will recommend angioplasty treatment.

Coronary balloon angioplasty has been in the ascendant since it was first mentioned in The Lancet in 1978. It is a relatively simple procedure and involves the threading of a tiny balloon through blocked arteries and expanding it to clear them, usually by pressing atheronatous (fatty) plaques against the coronary artery wall.

When angioplasty started to be used, the "gee whizz" technique was coronary bypass surgery, then one of the wonders of the modern medical world.

As angioplasty became more sophisticated, so it gained ground on bypass surgery. It was considered cheaper, easier to perform and far less traumatic and is now seen virtually as the heart disease cure all, offered to angina sufferers, those recovering from a heart attack, and as a just in case remedy for those concerned about the state of their arteries.

In 1990, 200,000 people in the US were treated with the procedure, and a further 100,000 in Europe, yet "only a few prospective trials had assessed its efficacy", stated the New England Journal of Medicine (2 January, 1992).

Not that the medical profession had much to worry about, it seemed. Initial tests showed an extraordinary success rate, some ranging above 90 per cent, with complications therefore in fewer than 10 per cent of cases. Even Mother Teresa, in her 81st year, received the treatment, giving it a by then unneeded added endorsement.