Heart Medications Archive

Discomfort usually resolves with a lower dose or a different statin.

A rare but worrisome side effect of taking a cholesterol-lowering statin is the breakdown of muscle tissue. To guard against it, people who take statins have often been advised to have regular blood tests to spot rising levels of creatine kinase (CK), a byproduct of muscle breakdown. Doctors hoped the tests would help identify the earliest stages of rhabdomyolysis, the most severe form of muscle breakdown, which can result in kidney failure and death (see box).

Failure to take the drug may be the most common reason.

Despite aspirin's low cost and availability without a prescription, it is a powerful drug: its antiplatelet activity helps prevent clots from forming inside stents or arteries. That's why people with coronary artery disease who take aspirin have fewer heart attacks and strokes than people who don't take aspirin.

Figuring out who is taking their pills is about to get easier. The FDA recently approved a "smart pill" that can tell whether a medication has been taken as prescribed. Made by Proteus Digital Health, the small pill is made primarily of silicon and embedded with a microchip sensor no bigger than a grain of sand. When activated by stomach acid, the sensor transmits a signal to a skin patch that indicates that a medication has been swallowed. The patch sends the information to a smartphone app, along with the wearer's heart rate, temperature, and activity level. The battery-operated patch must be changed weekly.

With about 50% of people not taking their medications properly, U.S. doctors are excited about the potential of this technology, particularly in diseases where medications are vitally important to survival or the prevention of serious side effects. It is also expected to help doctors refine dosages and measure benefits.

Q. I have had atrial fibrillation for a year, and I have felt pretty normal on a beta blocker (metoprolol) and digoxin. However, I recently began to feel very fatigued and noticed that my heart rate was only about 35 beats per minute. We stopped those medications, and my heart rate came up. I feel better. Are these drugs dangerous for me?

A. I wouldn't say they are dangerous, but as you learned, there can be too much of a good thing. Both the beta blocker and the digoxin slow the conduction of electrical activity in your heart and prevent it from beating too quickly and inefficiently (e.g., at 100 beats per minute). However, if you take too much of these medications, your heart rate becomes too slow to meet your body's needs.

Erectile dysfunction drugs may do what no others have done.

Sildenafil (Viagra) treats erectile dysfunction (ED) by blocking (or inhibiting) an enzyme called PDE5. This relaxes arteries that send blood to the penis, causing it to enlarge. Viagra and similar ED drugs also relax the arteries of the heart. Now there is evidence that PDE5 inhibition may be an effective treatment for heart failure (HF). Harvard researchers have shown that Viagra can improve exercise capacity in people with this chronic disease. In May, the researchers received a $26.3 million grant from the National Institutes of Health to study whether the PDE5 inhibitor Cialis can extend length of life in people with heart failure and reduce heart failure-related hospitalizations.

Concentrate on lowering LDL for now, experts advise.

HDL cholesterol is called "good" cholesterol, because higher levels of HDL are associated with lower risk of heart attack. But researchers are now questioning whether HDL protects the heart, and whether raising low levels is beneficial.

Harvard researchers studied individuals with genetically higher-than-normal HDL. In this study, published online May 12, 2012 in The Lancet, they expected a 13% lower risk of heart attack in individuals with the genetic variant. However, the risk was the same as in people who did not have the gene. "This suggests that just because an intervention raises HDL cholesterol, we cannot assume that risk for heart attack will drop," says principal study author Dr. Sekar Kathiresan, director of preventive cardiology at Harvard-affiliated Massachusetts General Hospital. "This highlights the difference between cause and association."

Cholesterol-lowering statins are a lifesaving therapy for many. But even at high doses, statins don't always produce ideally low levels of harmful LDL cholesterol.

Researchers in the TIMI Study Group at Harvard Medical School, led by Dr. Marc S. Sabatine, are testing a novel drug that may help patients reach their LDL goal safely. AMG 145 works differently than statins by binding to a protein called PCSK9, which assists in the turnover of LDL cholesterol receptors that help clear LDL from the blood. AMG 145 allows more of these receptors to circulate and remove LDL from the bloodstream. "Because AMG 145 is complementary to statins, using both should lead to greater benefit," says Dr. Sabatine.

Q. I am a 62-year-old female with no chronic health problems, but I am about 10 pounds overweight. My new doctor wants to put me on a statin immediately. My total cholesterol is 187: my LDL is 129, my HDL is 47, and my triglycerides are 55. He is concerned because my father died of a heart attack from coronary artery disease. The doctor wants my HDL to be above 60 and my LDL to be below 100. Could this result be achieved by weight loss, dietary changes, and exercise alone? If not, which statin would you recommend?

A. It's wonderful that you and your physician are giving thoughtful attention to your risk for heart disease. As you probably know, your LDL and HDL numbers are not really ominous. I assume from the absence of any mention of high blood pressure, diabetes, or cigarette smoking that you do not have these other risk factors for heart disease. Thus, the real question is whether your family history of heart disease suggests a genetic tendency to atherosclerosis, despite your fairly reassuring risk factor profile.

More than 12 months of treatment might not be necessary.

More than one million men and women in the United States undergo artery-opening angioplasty and stent placement each year as a nonsurgical alternative to open heart surgery. Afterwards, most take the combination of clopidogrel (Plavix) and aspirin (called "dual antiplatelet therapy") to prevent platelets from sticking together and forming a blood clot inside the stent. Some people take aspirin with prasugrel (Effient) or ticagrelor (Brilinta) instead of clopidogrel.

An aspirin a day has been shown to lower the risk of a first heart attack in men and a first stroke in women, but it also increases the risk of major bleeding in the digestive tract or brain.