Heart Medications Archive

A trio of studies bolsters evidence of their benefits and long-term safety.

Cholesterol-lowering statins have been around for a quarter-century, with a generally strong record of benefits outweighing risks. Indisputably, these drugs substantially reduce the number of heart attacks in people with or at risk for heart disease.

Catheters — thin plastic tubes that doctors route through the body's arteries and veins — can carry everything from tiny cameras to replacement heart valves. So why not clot-busting drugs?

That was the idea behind a Norwegian study that looked at nearly 200 people who had a blood clot in a leg vein (deep-vein thrombosis, or DVT). People with DVT usually take a blood thinner like warfarin to prevent the clot from growing and to stop new ones from forming. These drugs also keep the clot from fragmenting and traveling to the lungs — a potentially life-threatening complication known as a pulmonary embolism.

If you have resistant high blood pressure (hypertension), you are probably already doing a lot to lower it. But a study suggests that people with resistant hypertension rarely get two particularly effective drugs, and often they get a drug combination that's not very helpful.

Resistant hypertension occurs when blood pressure stays high despite taking three or more drugs, or when a person needs four or more drugs to reach blood pressure goals. Colorado researchers reviewed insurance claims for more than 140,000 such people. Only 3% were receiving chlorthalidone (Hydone, generic), a diuretic (water pill) that several studies suggest is more effective at reducing blood pressure and curbing bad cardiovascular consequences than the most-often-prescribed diuretic, hydrochlorothiazide (HydroDiuril, generic).

The physical act of taking most medications is simple: pop a pill in your mouth, and gulp it down with water. But people often don't take their medications when and how they should. Cost is one barrier, of course. So are complicated dosing regimens, side effects, and medication pick-up hassles.

Not taking medications as prescribed — what doctors call nonadherence — has profound personal, public health, and economic consequences (see "Striking statistics"). You and your doctor play important roles in remedying the problem.

To switch or not is a decision for you and your doctor to make.

Warfarin's long reign as the drug for preventing stroke in people with atrial fibrillation is being challenged by the second new blood thinner to come on the market within the span of less than a year.

Q. My systolic blood pressure is high in the morning (about 165), but in the evening it drops to below 100. I am taking two blood pressure medications daily and still experiencing seriously low blood pressure at night. What would you suggest?

A. Everyone's blood pressure changes throughout the day, and it's often highest in the morning and lowest at night. You seem worried about the low pressure at night, but that would concern me only if it's accompanied by symptoms such as dizziness or fainting. A systolic (top number) pressure below the normal of 120 is usually not worrisome. In fact, studies show that low blood pressure while you are sleeping predicts low cardiovascular risk.

Q. After a heart attack six years ago, I went on Lipitor (atorvastatin) because my doctor said it was proven to reduce the risk of a second heart attack in high-risk people like me. Three years ago, I switched to a generic (simvastatin) to save money. Now that Lipitor is going generic, should I switch back? And can I be assured that the generic version will be as effective as brand-name Lipitor at preventing a second heart attack?

A. The statins are a great class of drugs, and I don't think there is any reason to switch from one statin to another as long as you are reaching your LDL cholesterol goal and are not having side effects.

Q. I've read that if you take aspirin every day, stopping it temporarily increases your chance of having a heart attack even higher than it would have been if you had never taken aspirin. Is that true? If I need to stop taking aspirin for some reason, is there a safer way to do it than stopping cold turkey?

A. What you are describing is sometimes called the rebound effect or rebound phenomenon. It occurs when a person stops taking a medication and the symptoms or problem that the medication had controlled reappear, but more severely than before the person started taking the medication. Although a rebound effect has been seen with some beta blockers and some sedatives used to treat insomnia, it is unlikely this happens with aspirin.

COURAGE not followed by action

Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS. Optimal medical therapy with or without PCI for stable coronary disease. New England Journal of Medicine 2007; 356:1503-16.

Borden WB, Redberg RF, Mushlin AI, Dai D, Kaltenbach LA, Spertus JA. Patterns and intensity of medical therapy in patients undergoing percutaneous coronary intervention. JAMA 2011; 305:1882-9.

Problems in arteries supplying the legs, kidneys, and elsewhere pose problems for the heart, too.

The arteries that supply the heart (coronary arteries) and the brain (carotid arteries) get far more attention than the vast network of arteries below the heart. These so-called peripheral arteries are often overlooked — and a study suggests that problems in these blood vessels are often undertreated — even though they cause as much mayhem as problems in the coronaries and carotids.