Heart Disease Treatments
Common Drugs Used

Heart Disease Treatments and Senior HealthLifestyle changes are of course the first line of prevention and treatment of cardiovascular disease.

Conventional medicine recommends medical interventions ranging from drugs to surgery. For example, a bypass operation may be performed to reduce a person's risk of a heart attack, or to try to help stop any further heart attacks from taking place. When this operation is performed a blood vessel from another body area is used to ‘re-route’ blood around the blocked artery.

Many prescription medications are used every day to help prevent or control coronary heart disease (CHD). However, if medications are needed lifestyle changes still must be undertaken for results to take effect.

Common Drugs used to treat CHD include:

Aspirin helps to lower the risk of a heart attack for those who have already had one. It also helps to keep arteries open in those who have had a previous heart bypass or other procedure.

However, because of its side effects aspirin is not approved by the Food and Drug Administration in the US for preventing heart attacks in healthy individuals with careful assessment.

Some of the most common aspirin side effects are stomach pain, heartburn, nausea and vomiting. (An aspirin overdose or higher dosage than recommended can cause very serious health issues).

Long-term use of Aspirin has shown to cause gastrointestinal tract complications, including micro-bleeding and ulcers. There is also a risk of haemorrhagic stroke.

ACE (angiotensin converting enzyme) inhibitors stop the production of a chemical that makes blood vessels narrow and is used to help control high blood pressure and help heal damaged heart muscle. It may be prescribed after a heart attack to help the heart pump more efficiently. It is also used for heart failure cases.

Side effects may include a dry cough, headache and dizziness. ACE inhibitors may also cause elevated amounts of potassium. More rare side effects can include skin rashes, kidney problems, and swelling of the face, lips and throat.

Example drugs: Benazepril (Lotensin), Captopril (Capoten), Enalapril (Vasotec), Fosinopril (Monopril), Lisinopril (Prinivil, Zestril), Moexipril (Univasc), Perindopril (Aceon), Quinapril (Accupril), Ramipril (Altace), Trandolapril (Mavik).

News Heart Disease TreatmentsMany heart disease patients who are already receiving state-of-the-art therapy do not benefit from additional treatment with angiotensin converting enzyme (ACE) inhibitors, according to results of a new study funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health. The study provides the most definitive evidence to date of the effect of the drug in stable heart disease patients. Researchers found that ACE inhibitors do not lower the risk of cardiovascular death, heart attack, or the need for coronary revascularization (bypass surgery or angioplasty to restore blood flow to clogged arteries).

New Orleans, LA, Nov. 7, 2004http://www.nhlbi.nih.gov/new/press/04-11-08a.htm

Angiotensin II Receptor BlockersAngiotensin II constricts blood vessels and causes the kidneys to retain more fluid. The main function is to increase blood pressure. Angiotensin II receptor blockers (ARBs) inhibit the effects of angiotensin II by blocking the receptor, thereby reducing constriction and helping to reduce blood pressure.

ARBs also help to minimize over-exertion of the heart muscle and help prevent progression to heart failure. ARBs are mainly used when ACE inhibitors are not tolerated by the individual.

Side effects may include headache, lightheadedness, nasal congestion, back and leg pain, diarrhea, rash, indigestion and insomnia. More rare side effects may include kidney failure, liver failure, allergic reaction, reduced white blood cell count and swelling of tissues (angioedema).

Because ARBs can cause birth defects they are not recommended if pregnant or planning to become pregnant.

Example drugs: Candesartan (Atacand), Eprosartan (Teveten), Irbesartan (Avapro), Losartan (Cozaar), Olmesartan (Benicar), Telmisartan (Micardis), Valsartan (Diovan).

News Heart Disease TreatmentsDo angiotensin II receptor blockers increase MI risk, or do they not?A pair of articles in ‘Circulation’ magazine/journal discusses the controversy over whether or not angiotensin-II-receptor blockers (ARB) result in a paradoxical increase in risk of myocardial infarction (MI), despite reducing blood pressure. (Also raised, in a BMJ editorial in 2004.)

Suggesting that these drugs do increase the risk of MI argue firstly that in general, clinical trials with ARB have not shown the reduction in MI risk that could have been expected given the drop in blood pressure that they achieve. They discuss the major trials involving ARB, and also the various (and discordant) meta-analyses that have been carried out….

http://www.nelm.nhs.uk/Record Viewing/viewRecord.aspx?id=569354

AntiplateletsBlood clots can block blood flow to the heart or brain, causing a heart attack or stroke. Antiplatelet medications work by preventing platelets from sticking together to form blood clots to reduce the risk of a heart attack or stroke occurring, specifically in people who have already had a heart attack or stroke, or who have poor circulation that causes pain.

Possible side effects include allergic reaction (sneezing, respiratory congestion, swelling of throat, restricted breathing, itching or skin rashes), nausea, indigestion or stomach pain, unusual bleeding or bruising, ringing in ears (tinnitus), bloody urine, convulsions or seizures (rare).

Example drugs: Clopidogrel (Plavix), Ticlopidine (Ticlid).

Beta blockers slow the heart and make it beat with less force, so blood pressure drops and the heart works less hard. It is used for high blood pressure, chest pain and to prevent a repeat heart attack.

The most common side effects are cold hands and feet, tiredness and sleep disturbance (nightmares). Less common side effects include, impotence, dizziness, wheezing, digestive tract problems, skin rashes and dry eyes.

Example drugs: Acebutolol (Sectral), Atenolol (Tenormin), Atenolol Injection (Tenormin Injection), Bisoprolol (Zebeta), Carteolol (Cartrol), Metoprolol ER (Toprol XL), Metoprolol Oral (Lopressor), Nadolol (Corgard), Pindolol (Visken), Propranolol (Inderal), Propranolol ER (Betachron ER, Inderal LA, Innopran XL), Timolol Oral (Blocadren).

News Heart Disease TreatmentsGuidelines issued by the NHS drugs watchdog have given new advice on which medicines should be used to treat high blood pressure. They recommend that beta-blockers should no longer be routinely used, expect in special situations….

There is also increasing evidence that the most frequently used beta-blockers can carry a higher risk, some studies suggest up to 30% higher, of provoking type 2 diabetes than the new drugs. Many of the new medicines also have fewer side effects than beta-blockers.

http://news.bbc.co.uk/1/hi/health/5124382.stm

Nitrates (including nitroglycerine) – relax blood vessels and stop chest pain.

Side effects include a feeling of pulsating fullness in the head (most common side effect) or a headache, a drop in blood pressure, which can cause dizziness or a burning sensation under the tongue.

Example drugs: Isosorbide Dinitrate, Sublingual and Chewable (Isordil, Sorbitrate), Isosorbide Mononitrate (Imdur, Ismo, Isotrate ER, Monoket), Nitroglycerin ER (Nitroglyn), Nitroglycerin Ointment (Nitro-Bid Ointment, Nitrol), Nitroglycerin Skin Patches (Deponit, Minitran, Nitro-Dur, Nitrodisc, Transderm-Nitro), Nitroglycerin Spray (Nitrolingual).

Calcium channel blockers – relax blood vessels and are used for high blood pressure and chest pain.

Side effects can include drowsiness, increased appetite, weight gain, breathing difficulties (shortness of breath, coughing, or wheezing), irregular or slow heartbeat, allergic reactions (skin rash or hair loss), constipation, tenderness or bleeding of the gums, swelling of feet, ankles and legs, and fainting.

Example drugs: Amlodipine (Norvasc), Bepridil (Vascor), Diltiazem ER (Cardizem CD, Cardizem LA, Cardizem SR, Cartia XT, Dilacor XR, Diltia XT, Taztia XT, Tiamate, Tiazac), Felodipine (Plendil), Isradipine (DynaCirc), Nicardipine (Cardene), Nicardipine SR (Cardene SR), Nifedipine ER (Adalat CC, Afeditab CR, Nifediac CC, Procardia XL), Nisoldipine (Sular), Verapamil (Calan, Isoptin), Verapamil Extended-release (Calan SR, Covera-HS, Isoptin SR, Verelan, Verelan PM).

Oral Anticoagulants - these are like antiplatelets, but work to dissolve blood clots that have already formed. By dissolving the blood clots anticoagulants can lower the risk for heart attack and stroke.

Side effects may include bleeding from gums, nosebleeds, pinpoint skin spots, heavier bleeding, cough or hoarseness, fever or chills, lower back or side pain, painful or difficult urination, skin rash, hives and itching, blisters, blue or purple toes, ulcers, or white spots in mouth or throat, swelling of face, feet, or lower legs and yellow eyes or skin.

Example drugs: Warfarin (Coumadin, Jantoven), Hepalin injection.

Salicylates - reduce pain and swelling by blocking the body's production of chemicals that cause inflammation.

Salicylates (see Aspirin above) are also used to help prevent platelets from sticking together to form blood clots. These medications can reduce the risk of heart attack or stroke, specifically in people with poor circulation.

Side effects can include bloody stools, bloody or cloudy urine, fever, chills, pain in lower back, skin rash, hives, itching, ulcers, white spots on lips or in mouth, sore throat, stuffy nose, swelling of face or extremities, unusual bleeding or bruising, tiredness or weakness, vomiting, weight gain, yellow eyes or skin, heartburn or indigestion nausea, vomiting, or stomach pain, drowsiness, trouble sleeping, nervousness or jitters.

Example drugs: Aspirin Gum.

Diuretics (‘water pills’) - decrease fluid in the body and are used for high blood pressure.

Side effects may include black stools, blood in urine, cough or hoarseness, fever or chills, joint pain, lower back or side pain, pinpoint red skin spots, skin rash or hives, stomach pain, nausea and vomiting and yellow eyes or skin.

Diuretics can also be associated with potassium and/or sodium loss…

Signs of potassium loss can include dryness of mouth, increased thirst, irregular heartbeat, mood changes, muscle cramps or pain, nausea or vomiting, unusual tiredness or weakness and a weak pulse.

Signs of sodium loss can include confusion, convulsions, decreased mental activity, irritability, muscle cramps and unusual tiredness or weakness.

Blood cholesterol-lowering agents - decrease LDL cholesterol levels in the blood.

Side effects include soreness, aches, pain, weakness, fatigue, difficulty walking or getting out of bed. Also many reports exist on the use of Statin drugs and muscle or nerve damage.

News Heart Disease TreatmentsHigh Doses of Statins Carry Dangers, Swedish Report Says (press release)July 14, 2006

The American National Cholesterol Education Program said last year that people at high risk of heart disease should be treated more aggressively. Aggressively lowering cholesterol means that LDL cholesterol should be lowered to less than 1.81 millimoles per liter of blood (mmol/l) in high-risk individuals. Current guidelines generally recommend 2.56 mmol/l.

According to Uffe Ravnskov, an independent researcher from Lund, Sweden, achieving this new goal would mean that most of the western world's adult population would be on statins, and doses would have to be more than eight times higher than currently used.

Doses this high would increase both the number and seriousness of side effects, Ravnskov's team contended. Side effects could include heart failure, myalgia and rhabdomyolysis (which destroys muscle tissue), neurological problems and cancers.

In addition, the researchers claimed that clinical trials suggest that higher doses of statins do not lower overall mortality, and side effects are generally under-reported.

(http://www.newstarget.com)

Thrombolytic agents - also called ‘clot busting drugs’, given during a heart attack to break up a blood clot in a coronary artery in order to restore blood flow.

Side effects may include bleeding from cuts, gums, or wounds, fever, low blood pressure, agitation, bloating, blue or purple toes, blurred vision, bruising, changes in facial skin, chest discomfort, chills, confusion, decreased urine output, depression, dizziness, irregular breathing, skin flushing, headache, indigestion, lethargy, muscle cramps or spasms, twitching, nervousness, numbness, pounding in the ears, rapid weight gain, shortness of breath, sweating, swelling of eyes, face, lips, or tongue, unusual tiredness or weakness, vomiting, weakness in arms or legs, and yellow eyes or skin.

Example drugs: Alteplase (Activase), Anistreplase (Eminase), Reteplase (Retavase),Streptokinase (Streptase), Tenecteplase (TNKase), Urokinase (Abbokinase).

Glycoprotein IIb/IIIa Inhibitors - these are antiplatelet medications that work by preventing the blood from clotting during chest pain or a heart attack, or when undergoing surgical or procedural treatment.

Side effects may include bleeding, stomach, intestines, or other internal organs, increased bruising, stomach irritation and allergic reaction.

Example drugs: Abciximab Injection (ReoPro), Eptifibatide (Integrilin), Tirofiban (Aggrastat).

Return from Heart Disease Treatments to Heart Problem