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Heart Disease Medications

Heart Disease Medications

Rose Marie Robertson, MD, FAHA, FACC, FESC (Chief Science Officer and Past President of the Board of American Heart Association) gives expert video advice on: How soon will I start to feel better after taking heart medication? and more...

Why is aspirin important for people with heart disease?

Aspirin is important for people with heart disease because many of the problems that you have with coronary artery disease are caused by clots, and aspirin is a good way to prevent clots. When people come into the hospital with acute coronary syndromes, or heart attacks and unstable angina, old names for the same thing, it's almost always because they have a clot in a coronary artery. Sometimes it's completely blocking the artery, sometimes it's blocking it only partially, but in either case they're having symptoms because of that clot. And aspirin helps the body not form more clots in that area. And when we do procedures or give drugs to open up the artery to dissolve that clot, aspirin is critical to have there at that time to keep new clots from forming.

What is an "ACE inhibitor"?

ACE inhibitors are medications that we use to control blood pressure in many patients, and they act on what's called the Renin-Angiotension system. That's a system, in the body, of chemicals that act together to raise blood pressure and to constrict blood vessels. Sometimes we need those chemicals there, but in the case of patients with coronary heart disease and with heart failure, in fact, we need to inhibit the ability of those chemicals to be formed in greater quantities, and ACE inhibitors prevent those chemicals from acting to vasoconstrict, or shrink, the blood vessels, raise the blood pressure, and make it harder for the heart to work. We know from a number of clinical trials that they are important to prolonging life in people with coronary heart disease.

What is a "beta blocker"?

A beta blocker is a medication that affects the ability of the sympathetic nervous system to raise the heart rate and to activate the heart. Beta blockers are quite an important medication. When someone has a heart attack or has heart failure, the sympathetic nervous system can be over-activated in a way that's actually deleterious in the long run. Beta blockers have demonstrated their ability to prolong life and to prevent sudden cardiac death in patients with coronary artery disease and heart failure, and are a critical part of the medication regimen in patients with those disorders.

What is a "diuretic", and why is it important for treating heart disease?

A diuretic is medicine that helps the kidney get rid of fluid from the body. It used to be particularly important in heart failure, because patients would accumulate fluid and then would have symptoms of ankle swelling. Fluid retention that would make them very short of breath, particularly when they would lie down at night, and a diuretic was really the only way to get rid of that fluid. We now have very effective other medications in heart failure, so although we still use diuretics in heart failure, they're not quite as critical as they used to be. On the other hand, in hypertension and high blood pressure, we now know that starting with a diuretic is really the safest and best way to treat people with high blood pressure. Diuretics have been around a long time, they're old-fashioned and quite safe medications, and we now have evidence that these rather inexpensive medications are just as good, as a starting medication, as many more expensive ones.

What is an "anti-anginal medicine"?

Anti-anginal medicines are medications that are specifically designed to prevent or reduce the symptoms of angina. Angina is that feeling of chest discomfort that occurs when there's insufficient blood flow to the heart. And we have many anti angina medications, such as beta blockers and nitrates, that can greatly reduce the symptoms of angina. Calcium channel blockers would be another example of anti angina medications.

How soon will I start to feel better after taking heart medication?

If you're having symptoms from heart disease, such as shortness of breath or chest discomfort, you can expect to start feeling better very soon after taking heart medication. Most heart medicines begin to act within hours, and the great majority of them have their full effect within a day or several days. It is important to realize that some of the medications we use, for example, to treat high blood pressure or other risk factors may actually take as long as a week or two. Medications we use to treat cholesterol may take longer than that to have their full effect. But, those in general, are not things that are making you feel bad; they're things that are putting you at risk. So in terms of symptoms, in general, if you're not feeling better within a few days of seeing the physician in their office, you ought to be calling back and asking if there's a problem.

What side effects should I expect from cholesterol lowering medication?

Many cholesterol lowering medications can be taken with no side effects at all, and in fact, these days it's very common for us to be able to really perfectly well control cholesterol levels and have the patient really have no sense that they're taking a pill at all. That's particularly true of the statins, which in most people have no side effects. However, there are a couple of side effects that you should be aware of because they can be important. A few people who take statins will have problems with muscle pain, and that muscle pain can turn into a serious problem because you can actually have muscle cells be sufficiently damaged that they release what's called myeglobin. If that myeglobin rises to high enough levels, it can damage the kidneys. So, developing muscle pain after you've been started on a statin is a reason to call your physician on that day. If you develop dark urine, a dark color to the urine after you've started a statin or after the dose has been increased, that would be a reason to stop taking the statin long enough to call your physician, and ask for advice. With statins, occasionally liver function tests, blood tests that we measure, can go up, but in most cases they will come back down again without really any change. Still, blood tests need to be checked. Now there are other cholesterol lowering medications and they have different kinds of side effects, potentially. Again, many people take them without any side effects at all. Some of the medications can cause some nausea, constipation or symptoms in the GI tract. Others, particularly niacin, can cause flushing, a feeling of heat and redness. Again, many of these side effects either will disappear over time or can be managed. But, it's important to let your physician know if you develop any side effects with the medicine because we would like to find a regimen that makes your levels perfect without having you have to suffer side effects. We certainly want to be certain that you don't suffer any side effects that would cause you any serious problem.

Are heart disease medications under-prescribed?

The medications that we have available to prevent heart disease now, are really seriously under used. So, there's no question that we also under use advise about our life style. We don't spend enough time with patients explaining to them what a healthy life style should be. In terms of diet, and physical activity. Once we've explained those things and they've tried those, it's very important that we not let it rest there. That we use the medications that we have to control these risk factors. Leaving blood pressure uncontrolled which happens in a great majority of people in this country. Many people who have high blood pressure, don't even know they have it. Even if they know they have it and they're on treatment for it, they're often not treated to go. Their blood pressure really isn't brought down into the non-hypertensive range. That's a pitty because we can now effectively control high blood pressure in nearly every one with out side effects and greatly reduce their risk. Same thing is true for cholestoral. So we need to do a better job having physicians make the diagnosis of a risk factor, and then really treat it to goal. We need patients to know their numbers, and to want them to be treated to goal.