Heart Medications Archive

Reduce your risk of a heart attack, stroke, or death.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for relieving pain, reducing inflammation, and calming fevers. Some low-dose NSAIDs are available over the counter—for example, ibuprofen (Advil, Motrin) and naproxen (Aleve). This leads people to believe they are completely safe. But, since NSAIDs were first introduced, there were theoretical reasons to believe they might (infrequently) cause heart problems. This concern was amplified in 2004 when the prescription NSAID rofecoxib (Vioxx) was found to increase the risk of heart attack and stroke. Since then, Vioxx and several related NSAIDs have been taken off the market.

Walking may be the best place to start.

Fatty blockages in the leg arteries can cause pain in the thigh or calf muscle that occurs when walking and disappears with rest. Pain occurs when the blockages restrict blood flow to the working leg muscles. This condition is called intermittent claudication, and it can become disabling.

At the point when leg pain prevents a person from walking very far, treatment may include medication, exercise, or a procedure to restore blood flow. Harvard doctors recommend starting with walking.

Low doses for rhythm control may be safe, doctors say.

Digoxin is a medication often used to treat atrial fibrillation, one of the most common heart rhythm disturbances. This disorder causes the heart to beat rapidly and irregularly. Digoxin lowers the heart rate and helps bring it under control.

Novel drug improves breathing and appears to extend life.

It may be hard to imagine that a drug derived from a hormone associated with pregnancy could improve the symptoms of heart failure, but that's what serelaxin appears to do. In clinical trials of people hospitalized with new onset of sudden (acute) heart failure, the drug significantly improved shortness of breath (a condition doctors call dyspnea), one of the most frightening and persistent symptoms of the disease. It also reduced organ damage caused by poor blood flow and reduced deaths.

Aspirin reduces the risk of a second heart attack or stroke by 20%, yet doctors prescribe it for less than half the people who might benefit from it.

Q. I thought one of the reasons to receive a heart valve made from cow tissue was that you don't have to take blood thinners. Now my doctor is telling me that I will need to take warfarin [Coumadin] for several months after I have my aortic valve replaced. Has the thinking changed?

A. You're right—thinking is evolving on whether people who receive a bioprosthetic (natural-tissue) valve benefit from warfarin therapy. The trend is toward using this treatment for three to six months unless the person has a history of bleeding that would make anticoagulation dangerous. Bioprosthetic valves are used more often than mechanical valves in older people undergoing aortic valve replacement, because they are often frail and have conditions that predispose them to bleeding complications. However, recent research shows that three to six months of warfarin seems to lead to lower rates of blood clots than bleeding complications. The risk of blood clots—and thus the benefit of taking warfarin—is greatest in the first three months, and then declines. After six months, the benefits and risks seem too close to recommend the medication. So unless you have a high risk of bleeding, I would make the same recommendation. Make sure you are followed closely after surgery to be sure that your blood is thinned to an appropriate level.

Multidrug combinations may make medicines easier to swallow.

A new study provides strong support for the concept of a single pill that contains multiple medications used to fight heart disease. The idea stems from the decades-old practice of bundling two or three medications into one pill to treat a single disease, such as high blood pressure. The new combination pills put even more medicines into one pill. These medicines fight heart disease directly as well as indirectly by lowering blood pressure and cholesterol. Many doctors have been skeptical of packaging multiple medications into one pill, yet two prior studies have provided support for the concept in reducing heart disease.

The newest study, presented at the annual meeting of the American Heart Association in November 2012, may help change some minds. The Use of a Multidrug Pill in Reducing Cardiovascular Events (UMPIRE) trial found that people who took a pill containing two blood pressure medications, a cholesterol-lowering statin, and aspirin were 33% more likely to take their medications every day than those prescribed the same drugs in separate pills. As a result, their blood pressure and cholesterol were better controlled.

Don't be worried by occasional recalls, pharmacists say.

The December 2012 recall of generic atorvastatin pills manufactured by Ranbaxy, an FDA-licensed company in India, reignited concerns about the safety of generic medications. Although there were no reported injuries from small glass particles that found their way into the product, people taking the medication were understandably worried that the tablets might be dangerous. The incident underscored the fact that Americans are generally skeptical of generic medications, often viewing them as inferior to brand-name products.

Taking a multivitamin every day does not prevent heart disease. That's the conclusion of the Physicians' Health Study II (PHS II), the second phase of a long-running Harvard study that evaluated the effects of multivitamins and supplements of vitamin E, vitamin C, and beta carotene on the prevention of cardiovascular disease, cancer, eye disease, and thinking and memory problems.

After following the participants—all males over age 50—for an average of 11.2 years, the researchers found no statistically significant differences in rates of heart attack, stroke, heart failure, need for an bypass surgery or angioplasty, death from cardiovascular causes, or death from any cause between the men who took a daily multi-vitamin and those who took a placebo. As explained in The Journal of the American Medical Association, the men studied in PHS II were generally very healthy, ate well, and exercised. They may have obtained all the nutrients they needed from their diet.

Q. I recently had a drug-eluting stent placed in one of my coronary arteries after an episode of severe chest pain. My doctor told me I had to take Plavix every day. Now I feel perfectly fine–except for my right hip. I need a hip replacement, but my orthopedist wants to wait until I'm off Plavix before operating. How long is long enough to be on this drug?

A. A stent is a small cylindrical metal scaffold placed in a coronary artery to hold it open after a blockage has been pushed aside with a balloon. After stenting, it's important to take an antiplatelet drug like clopidogrel (Plavix) to prevent a blood clot from developing inside the stent. Blood-thinning drugs slow down the clotting process, so you would have a lot more bleeding during your hip surgery than you would if you were not on the medication.