What you need to know about your heart medications

by Carolyn Thomas  ♥  @HeartSisters

One of the most surprising additions to the daily morning routine since my heart attack has been the fistful of pills that I now take every day.

It can be a confusing mix of medications, each for a different purpose, and each with different benefits and side effects.  Here’s just a sampling of some of the more common cardiac meds that doctors prescribe for heart patients.

Anti-platelet drugs

This type of heart medicine can help prevent clots from forming in blood vessels. It accomplishes this by preventing sticky blood platelets from clumping together. Your doctor may prescribe anti-platelet medication if:

• you have had a heart attack
• you have had a coronary stent implanted in a coronary artery
• you have unstable angina
• you have had strokes, including TIAs (transient ischemic attacks)
• you have other types of heart disease
• your doctor has noted plaque buildup in your blood vessels
• you are at high risk for heart attack or stroke

Examples of anti-platelet medicine include aspirin, clopidogrel (Plavix), ticlopidine (Ticlid), ticagrelor (Brilinta – also known as Brilique and Possia in Europe), or prasugrel (Effient or Efient). Since side effects include increased bruising and bleeding, some people may not be able to take anti-platelet meds if they are already at high risk for bleeding.

Angiotensin-Converting Enzyme (ACE) Inhibitors

This type of heart disease medicine can help because they:

• lower your blood pressure
• make the heart’s work easier
• help the heart work more efficiently

ACE inhibitors work by preventing your body from making angiotensin II, a hormone that makes blood vessels tighten, to help your blood vessels remain relaxed. Blood flows more easily through the vessels, lowering your overall blood pressure. Your heart doesn’t have to work so hard to pump blood through your vessels. About 20% of patients who receive ACE inhibitors develop a dry cough, a side effect so debilitating that you may need to stop the drug; it’s particularly common in women and those of black or Asian background. Talk to your physician if this side effect occurs.  Quinapril (accupril),  Capoten (captopril) and Vasotec (enalapril) are examples of ACE inhibitors.

Calcium Channel Blockers (CCBs)

This type of heart disease medicine is also called a calcium antagonist. CCBs can:

• lower your blood pressure
• reduce chest pain (angina)
• help manage your heart rate (e.g. in atrial fibrillation)
  

CCBs prevent calcium from entering the muscle cells in your heart and blood vessels, keeping blood vessels from tightening and causing the heart to pump with less strength. Your heart rate slows and blood can flow more easily through the vessels, lowering your blood pressure. Cardizem CD (diltiazem) and Norvasc (amlodipine) are examples of CCBs. There’s also a drug that combines a statin (atorvastatin) plus a calcium channel blocker (amlodipine) called Caduet, a fixed-dose combination medication for the treatment of high cholesterol and high blood pressure.

Beta Blockers

This type of medicine diminishes the effects of adrenaline and other stress hormones. They  slow heart rate and reduce blood pressure, and are commonly used for treating:

• abnormal heart rhythm (e.g. atrial fibrillation)
  
• high blood pressure
• heart failure
• angina (chest pain)
• acute aortic dissection
• hypertrophic obstructive cardiomyopathy
• anxiety
• prevention of migraines.

Beta blockers also have been found to prevent further heart attacks and death after a heart attack, particularly in the first year post-diagnosis. (Some controversy exists over how long to recommend beta blockers for heart patients).  Other uses include the treatment of hyperthyroidism, akathisia (restlessness or inability to sit still), and anxiety. Some beta blockers are also used for reducing pressure in the eye caused by glaucoma.

Examples of beta blockers are Carvedilol, Bisoprolol, Metoprolol, Propanol, or Atenolol.

Cholesterol-Lowering Drugs

Cholesterol-lowering drugs may help those already at high risk for heart disease in these ways:

• lower LDL (bad) cholesterol levels
• raise HDL (good) cholesterol
• lower triglycerides (a fat in your blood)

Cholesterol-lowering drugs work in a variety of ways to improve your heart health. Some change the way the liver processes cholesterol and fat. Others affect the way your body digests nutrients, or prevent cholesterol from clumping through your blood vessels.

Statins (Lipitor, Crestor) lower LDL bad cholesterol levels and may keep fatty cholesterol streaks from forming in your blood vessels.  Tell your doctor immediately if you experience severe muscle pain or other serious side effects of statins.

PCSK9 inhibitors are also prescribed to lower cholesterol and are an alternative drug for those who can’t take statins.  PCSK9 drugs work by suppressing the PCSK9 enzyme. In 2015, the Food and Drug Administration (FDA) approved both evolocumab (Repatha), and alirocumab (Praluent), two PCSK9 inhibitors that require injections every two to four weeks. In 2018, Amgen (the manufacturer of Repatha) announced that the price of Repatha would be reduced by 60%, from an annual price of $14,100 (U.S.) down to $5,850.(U.S.)

In 2020, the FDA approved Nexletol and Nexlizet, two new non-statin drugs that clinical trials indicated may help reduce high cholesterol when taken with a statin.  The two new drugs have potential side effects that are different from those associated with statins such as kidney stones or gout, a risk of tendon rupture, respiratory infections, anemia, and elevated liver enzymes.  Ask your doctor about side effects.

Vasodilators

Vasodilator heart disease medicine has two effects:

• lowers your blood pressure
• eases chest pain (angina)

Vasodilators relax the muscles in your blood vessel walls. The vessels dilate (widen) and blood flows through more easily, lowering blood pressure and providing  more blood and oxygen to the heart so it doesn’t have to work so hard to pump. These drugs are often prescribed PRN – meaning take whenever you need them.  They also widen all blood vessels in your body, not just around your heart – including those to the brain, which can cause headaches for some patients.  Try taking a Tylenol™ about 20 minutes before taking any vasodilator to help avoid the famous ‘nitro headache‘.

Examples of vasodilators include nitroglycerin (pills, patch or spray), Isordil (isosorbide dinitrate),  Apresoline (hydralazine) and Loniten (minoxidil).

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NOTE FROM CAROLYN:  I wrote more about common cardiac meds (and managing side effects) in my book  “A Woman’s Guide to Living with Heart Disease“.  You can ask for it at bookstores (please support your local independent bookseller) or order it online (paperback, hardcover or e-book) at Amazon – or order directly from my publisher Johns Hopkins University Press (use their code HTWN to save 30% off the list price).

 ♥   Find out more about possible dangerous interactions between prescribed drugs.

♥   Is less really more? Deprescribing: fewer drugs, better health outcomes?

♥    Here’s a comprehensive patient-friendly glossary of cardiology terminology