Heart Medications Archive

Changes include adding new clot-preventing drugs and using less aspirin.

If you have atrial fibrillation (also called afib), your doctor may recommend changes to your treatment based on recently updated guidelines for managing this common heart disorder.

If you're taking a cholesterol-lowering statin, don't use it as an excuse to slack off on your diet and sneak in extra calories and fat. Apparently, that's what statin users have done in recent years, according to a JAMA Internal Medicine study that looked at diet records from nearly 28,000 adults over a 12-year period.

People who took statins ate 10% more calories and 14% more fat during 2009–2010 than they did in 1999–2000. No such increases were seen in people who were not taking statins, the researchers found. Among statin users, body mass index (BMI) scores rose an average of 1.3 points, which translates to about 9 pounds of weight gain over a decade.

If a clot blocks blood flow to the brain, causing an ischemic stroke, the sooner a person receives the clot-busting drug known as tPA, the better. In an effort to cut "door-to-needle time" (the time it takes a person to get the drug after arriving at the hospital), researchers launched the Target: Stroke initiative. Started in 2010, the initiative pushed 10 strategies to streamline and speed treatment in the hospital, such as early notification from emergency medical workers and a single-call system for alerting the stroke team.

An analysis of the three-year data, which involved more than 70,000 people in 1,030 hospitals, appeared in The Journal of the American Medical Association. The initiative boosted the percentage of eligible people with door-to-needle times of an hour or less, from just under 30% to just over 53%. The faster treatment was also associated with fewer complications and better outcomes. Under the new processes, more people were able to return home after treatment rather than to a rehabilitation facility, and fewer people died in the hospital.

Making plaque disappear is not possible, but it is possible to shrink and stabilize it. Drugs called statins can help with this, and so can eating a heart-healthy diet, exercising, and quitting smoking.

New guidelines are still controversial for older adults who don't appear to have heart disease.

The debate is still raging over last November's guidelines that changed who should take statins, the drugs that help lower cholesterol. For seemingly healthy adults, the guidelines take the focus off LDL or "bad" cholesterol as a marker for statin use, and place the focus on a person's risk factors for developing heart disease or stroke—such as older age, high blood pressure, diabetes, smoking, other family members with heart disease, tests that show calcium in the heart's arteries, or blood levels of C-reactive protein (CRP). "That's a huge change," says cardiologist Dr. Christopher Cannon, a Harvard Medical School professor.

Medications only work if they are taken—and often they are not. A study in the March 31, 2014, Annals of Internal Medicine finds that nearly a third of patients fail to fill first-time prescriptions. Not surprisingly, this is most common when drugs are expensive or when they are used to prevent conditions (like heart disease) that aren't yet causing symptoms. It's also more common when patients have higher copayments and are already taking many medicines for many different conditions. "I see too many people who go to lots of specialists, are given too many prescriptions, and get overwhelmed with so many pills that they just can't take any more," says geriatrician Dr. Suzanne Salamon, an instructor at Harvard Medical School. She suggests that you bring containers of all of your medications and vitamins (not just a list) to your primary care visits to talk about which ones you're really taking, which ones you think are helpful, and if there is a way to safely reduce the number of pills you take (there often is). If a copay is too high, ask your doctor if there is a less expensive version of the medication. Once you fill your prescriptions, make a chart to help you remember when to take the drugs.

Q. I was surprised to see spinach and kale recommended as "superfoods" for heart health in your
March issue. I take Coumadin for atrial fibrillation and have been told to avoid green leafy vegetables.
I had always enjoyed these foods in the past, so I'd be glad to know if it's okay to eat them.

A. Yes, you can eat these foods in moderation if you choose to, but check with your doctor first. Just take care to eat about the same amount on a day-to-day basis. The reason? Spinach, kale, and other leafy greens are all rich in vitamin K, which plays an essential role in forming blood clots. Warfarin (the generic name for Coumadin) helps prevent blood clots by blocking vitamin K's actions. As a result, it's important to keep your vitamin K levels stable, which, in turn, keeps your warfarin level stable. If your warfarin level gets too low, you risk a dangerous blood clot. If it's too high, you risk a serious bleeding problem.

New drugs help expand treatment options for pulmonary hypertension.

The common, garden-variety type of high blood pressure (what doctors call hypertension) affects vessels throughout the body. But a less common form affects the arteries that carry blood from the right side of the heart to the lungs. The vessels tighten, become stiff and thick, or develop blood clots.

Surprising new normal, healthy blood pressure for men by age 

What's good blood pressure for men by ages? As many as three-quarters of men over 65 have high blood pressure. Many end up taking medication to prevent heart attacks, heart failure, stroke, kidney failure, and erectile dysfunction.

For most people with blood pressure clearly in the red zone, getting their numbers below 140/90 millimeters of mercury (mm Hg) is a reasonable goal. However, in December 2013, a panel of experts convened by the National Institutes of Health (NIH) released a recommendation that people over age 60 with high blood pressure could settle for a goal of 150/90—not the more stringent standard of 140/90—and still get health benefits. The American Heart Association rejected the idea, and five of the 17 members on the NIH panel later publicly dissented with the majority opinion. The debate continues.

All medicines are associated with both benefits and risks. A new study finds that all medications to treat high blood pressure in older adults seem to be associated with an increased risk of serious falls. Researchers published their findings in the Feb. 24, 2014, JAMA Internal Medicine. They found that exposure to moderate or high doses of any medication to treat high blood pressure was associated with a 30% to 40% increased risk of falls with serious injury, compared with no use of the medications. That sounds like a large risk, but over three years, these were the risks of serious falls: 9.0% in those not taking blood pressure medicine, 11.6% in those taking moderate doses, and 10.9% in those taking higher doses. The association was stronger in people who had fallen and suffered an injury in the past. But there were no clear differences in injury risk between the drug classes, including diuretics, angiotensin-receptor blockers, beta blockers, ACE inhibitors, and calcium-channel blockers.

"These drugs do, after all, lower blood pressure, which could cause people to be lightheaded and even faint when suddenly standing after sitting. There is no question that treating blood pressure leads to reductions in the risk for stroke and heart disease, so if you feel lightheaded when standing, don't stop your medications. But tell your doctor about it, and exercise caution when standing up suddenly," says Dr. Thomas Lee, a cardiologist and internist at Harvard-affiliated Brigham and Women's Hospital.