| Lifelong Health: Phalanx of Drugs Fight Heart Disease, if Taken American medicine has made incredible strides in the treatment and management of heart disease. Combined with lifestyle changes, such as diet, exercise and the right combination of a few tried-and-true medications -- including aspirin, beta blockers, ACE inhibitors and statins -- patients with coronary artery disease can dramatically reduce the risk of heart attack and stroke.
Shockingly, many adults who have already experienced a heart attack or are at high risk of future problems fail to adhere to the recommended therapy.
For example, only 70 percent of patients with coronary artery disease are taking aspirin, perhaps the most important medication known to decrease the risk of heart attacks. Aspirin reduces the ability of platelets to clump together and attach to a coronary artery damaged by the deposition of cholesterol. While the recommended dose remains controversial, most studies indicate that two baby aspirins daily, each containing 81 milligrams of aspirin, is the optimum dose.
Not without side effects, aspirin can cause increased bruising or irritation of the stomach lining, which leads to indigestion and bleeding. For patients unable to tolerate aspirin, many physicians will prescribe either Plavix or dipyridamole. Patients with an increased risk of bleeding may be unable to take any of these medications.
Less than 50 percent of patients with heart disease are taking a beta blocker or an ACE (angiotensin converting enzyme) inhibitor. Both of these drugs reduce symptoms of chest pain and decrease the risk of heart attack and heart failure by relaxing coronary arteries and preventing spasms (which contribute to an acute heart attack). They also reduce blood pressure and the contractility of the heart muscle, both of which help prevent chronic damage to the heart.
Beta blockers, such as atenolol, can often make the heart rate slow excessively and can cause chronic fatigue, decreased libido, insomnia and even memory loss. Many patients find these side effects intolerable and elect to stop the therapy. However, this is poorly advised, as there are other choices available and newer beta blockers have been introduced with fewer side effects.
Often, patients fail to use ACE inhibitors because the therapy can cause a chronic cough. In addition, it may excessively lower blood pressure, which leads to dizziness or even fainting and falls. In this circumstance, a lower dose should be considered or more expensive alternatives can be prescribed.
In addition to the medications specifically targeted toward heart disease, many patients are not receiving statin medications that can dramatically lower cholesterol. As a general rule, anyone with coronary artery disease should have their bad, or LDL, cholesterol lowered to below 70. Not only do these drugs reduce the risk of heart attacks by decreasing the incidence of cholesterol deposits in coronary arteries, but they also decrease inflammation and prevent arteries from going into spasms.
Statins also appear to facilitate the formation of a collateral circulation where new blood vessels form and bypass blockages, assuring adequate blood supply to the heart muscle. Initially, a generic statin (lovastatin or simvastatin) should be prescribed. The more expensive and powerful drugs should be reserved for those patients in whom the generics are ineffective. About 10 percent of patients cannot tolerate statins because of severe muscle pain, fatigue or insomnia.
Treatment to prevent heart attacks should be prescribed to anyone who has had a previous heart attack or has coronary artery disease identified on an electrocardiogram (EKG), stress test or an angiogram. Patients who have angina (chest pain usually made worse by exertion) also have coronary artery disease. On occasion, these medications are given to patients at very high risk of developing heart disease, including those with diabetes, peripheral vascular disease (narrowing of the arteries to the lower limbs), or a history of carotid artery blockage or stroke.
Research is under way to investigate whether all of the drugs that alleviate heart disease can be incorporated into one pill. Not only would that simplify the issue, but it would also reduce cost, increase convenience and improve compliance.
If you have coronary artery disease and are not following the traditional therapy of medications, talk to your doctor. No challenges, whether financial or physical, are insurmountable. Failing to take every step to prevent and manage heart disease is simply irresponsible.
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Dr. David Lipschitz is the author of the books, "Breaking the Rules of Aging" and "Dr. Davids First Health Book of More Not Less." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.DrDavidHealth.com. Copyright 2010 Creators Syndicate Inc. |
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