Heart Medications Archive

Research we're watching

People may let healthy eating and exercise habits slide after starting prescription heart medications, according to a study in the February 18 Journal of the American Heart Association.

The study involved more than 40,000 Finnish people whose average age was 52. From 2000 to 2013, researchers surveyed them at least twice every four years about their body mass index and their exercise, smoking, and drinking habits. They used pharmacy records to track if the participants began taking blood pressure drugs or statins.

Several new technologies and medications that may benefit the heart are moving into cardiology care.

As regular readers of the Heart Letter know, our features tend to focus on lifestyle advice and currently available therapies for heart disease. As the new decade begins, we're also looking to the future. Editor in Chief Dr. Deepak L. Bhatt selected five promising new developments in cardiovascular research that you may be hearing more about in the coming years.

1. Digital stethoscopes

First developed more than 200 years ago, the instrument doctors use to listen to the heart and lungs has undergone some high-tech improvements in recent years. The latest digital stethoscopes feature specialized microphones and sensors that filter, buffer, and amplify sounds from the heart. The sounds are then converted to a digital signal and sent wirelessly to a smartphone, where the patterns can be visualized and further analyzed. Some models are so sensitive they can detect turbulent blood flow in the arteries of the heart, possibly enabling doctors to detect coronary artery disease. Studies assessing that potential use are currently under way.

Drugs that discourage blood clots (commonly called blood thinners) don't actually make the blood less viscous. The two main types of these drugs, anticoagulants and antiplatelet drugs, interfere with different blood components involved in clot formation. Anticoagulants treat blood clots in the legs and lungs and are also prescribed to people with atrial fibrillation. Antiplatelet drugs are used to prevent heart attacks and strokes and to treat people who receive stents.

On call

Q. I have atrial fibrillation and currently take warfarin (Coumadin) to prevent a stroke. I haven't had any problems with it, but I wonder if I should switch to one of the newer blood thinners. Are there any advantages?

A. For about 50 years, warfarin was the only choice for people who needed to take an oral anticoagulant (blood thinner). While warfarin is inexpensive, it has its downsides. People who take it must regularly undergo a blood test, called an INR, to ensure they are getting the proper dose. A person's blood should be "thin" enough not to clot easily, but not so thin as to pose a high bleeding risk.

People at high risk of heart disease get the most benefit from these costly drugs.

If you're a woman with diabetes, your risk of developing heart disease is four times that of a woman without diabetes. That means protecting your heart health should be a top priority. It starts with adopting heart-healthy lifestyle changes. But if you have a history of heart attack or stroke or are high risk for other reasons, your doctor may suggest a diabetes medication with extra benefits.

Women and their doctors can choose from a crop of new drugs that may reduce diabetes-related heart risks. "Today we're starting to try to customize or personalize an individual's preventive medicine. We take certain subgroups of patients — such as those with a past history of stroke, heart attack, or heart failure — and steer them toward specific drugs based on new data," says Dr. David Nathan, director of the Diabetes Center and Clinical Research Center at Massachusetts General Hospital and professor of medicine at Harvard Medical School.

Ask the doctor

Q. Your article about interval training in the September issue suggests a target heart rate of at least 80% of your maximum heart rate during the high-intensity intervals. But what about people like me who take drugs such as metoprolol, which lowers the heart rate? Should I adjust my target heart rate for exercise?

A. Metoprolol (Lopressor, Toprol) belongs to a class of drugs known as beta blockers. As you mentioned, these drugs reduce your heart rate; they also lower blood pressure. They work by blocking the effects of the hormone epinephrine (also known as adrenaline), causing your heart to beat more slowly and with less force. These drugs are often prescribed for people who have had a heart attack, as well as those with heart failure, atrial fibrillation, or angina.

Often described as "chest pain," angina may feel more like pressure or heaviness. Here's what you should know about the different types and treatments.

The word angina comes from the Latin word angere, meaning "to choke or strangle." To doctors, angina almost always means angina pectoris, or chest pain due to an inadequate supply of oxygen to the heart muscle (pectoris refers to the chest). But the neck, jaw, shoulders, and even the arm may also hurt during an angina attack.

In fact, many people who have angina don't describe the sensation as pain, says Dr. C. Michael Gibson, an interventional cardiologist at Harvard-affiliated Beth Israel Deaconess Medical Center. "Instead, they describe a sense of heaviness or pressure. Discomfort is probably a better word than pain," he says.

Research we're watching

If you've had a heart attack, national guidelines strongly recommend taking a high-intensity statin to prevent a second heart attack. But a study of Medicare recipients finds that where you live may affect your chances of receiving a statin prescription.

People living in New England were most likely to receive a high-intensity statin (74%), while those from the West South Central states (such as Arkansas, Oklahoma, and Louisiana) were the least likely (41%). The data came from nearly 140,000 people ages 66 and older who were hospitalized for a heart attack from 2011 to 2015. The findings were published online July 24 by JAMA Cardiology.

New guidelines provide advice on the role of drugs, weight loss, and procedures to cope with this common heart rhythm disorder.

The classic symptom of atrial fibrillation — a fluttering or thumping sensation in the chest — can leave you breathless, dizzy, and tired. Caused by electrical misfires in the heart's upper chambers (atria), this condition affects an estimated one in 11 people ages 65 and older.

While the symptoms of atrial fibrillation (often called afib) can be unsettling, the real danger is a heightened risk of serious strokes (see "How afib can lead to a stroke"). As many as 30% of strokes from afib prove fatal, notes Dr. Christian Ruff, a cardiologist at Harvard-affiliated Brigham and Women's Hospital.

Research we're watching

An experimental nasal spray shows promise for quickly treating an abnormally fast heart rhythm known as supraventricular tachycardia (SVT), a new study reports.

Caused by an electrical misfire that overrides the heart's natural pacemaker, SVT occurs unpredictably, lasting anywhere from minutes to hours. Although usually harmless, the condition can make people dizzy or lightheaded. People with persistent SVT usually need to go to an emergency room for an injection of a drug to slow the heart.