Heart Medications Archive


Ask the doctor: Should I switch to generic Lipitor?

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.

Ask the doctor: Can stopping aspirin cause heart problems?

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.

September 2011 references and further reading

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.

Peripheral artery disease often goes untreated

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.

"Polypill" test raises questions

The more pills a person needs to take each day, the less likely he or she will do it day in and day out. That's one reason British researchers proposed what they called the polypill. It would combine low doses of several generic (and thus inexpensive) heart-protecting medications — aspirin, a cholesterol-lowering statin, and two or three different drugs to lower blood pressure — into a single pill.

Putting theory into action, the Program to Improve Life and Longevity (PILL) Collaborative Group set out to test the polypill concept in people without heart disease but at higher-than-average risk for developing it. In a 12-week clinical trial conducted in seven countries, use of a polypill (see figure) lowered systolic blood pressure by 10 millimeters of mercury and LDL (bad cholesterol) by 30 milligrams per deciliter of blood compared with an identical-looking placebo pill (PLoS ONE, May 2011). Although these respectable reductions should, in theory, translate into a 50% reduction in heart disease, the study was too small and too short to track the pill's effect on heart disease or survival.

Update on aspirin

People with heart disease should take aspirin; the decision is trickier for those without it.

For survivors of a heart attack or a clot-caused (ischemic) stroke, and for almost everyone else with coronary artery disease, there's an across-the-board recommendation to take an aspirin a day. But what about folks who haven't been diagnosed with heart disease? Can an aspirin a day help them, too?

Surviving a heart attack: A success story

By Richard Lee, M.D.
Associate editor, Harvard Heart Letter

When I was a newly minted cardiologist, heart attacks were feared far more than they are today. They terrified people who were having them, and their families, because they were known killers. Heart attacks made doctors nervous, too, since we were less certain about how to treat them and the therapies available to us were less effective than the ones we have at our disposal today.

Unexpected benefit for digoxin?

Most medications have potentially harmful side effects, such as stomach upset with aspirin. A team from Johns Hopkins and Harvard universities found what looks to be a beneficial side effect for digoxin — lowered risk of prostate cancer. Digoxin, which was originally extracted from the foxglove plant, has been used for decades to treat heart failure and some heart rhythm problems.

Using an automated system, the researchers tested the ability of nearly 3,200 compounds to halt the growth of prostate cancer cells. Digoxin was one of the top five. As a real-world check, the researchers looked at nearly 48,000 men in the ongoing Health Professionals Follow-up Study. Those who had routinely taken digoxin were 24% less likely to have developed prostate cancer over the 20-year period of the study (Cancer Discovery, published online April 3, 2011).

Alternative to warfarin

People with atrial fibrillation are at higher risk of having a stroke because they are more susceptible to the blood clots that cause stroke. When the atria (the top two chambers of the heart) fibrillate (beat chaotically), blood collects in the heart, giving clots a chance to form. One of those clots can travel to the head, get stuck in a blood vessel there, and cause a stroke by depriving a part of the brain of the oxygen and nutrients it needs; some of the cells of the brain die, possibly taking with them the ability to move, speak, feel, think, or even recognize people.

Warfarin prevents blood clots by making the platelets in the blood less sticky. It's a good, time-tested drug. But warfarin is tricky to use. Some experience bleeding problems like nosebleeds. Yet if you take back the dose too far to avoid bleeding, you're back to where you started: running the risk that a blood clot may form and cause a stroke.

Beyond the coronary arteries: Possible benefits of statin drugs Part I: Meet the statins

For a young physician just entering practice today, life before the statins must seem like the dark ages of cardiology. Since the first statin was approved in 1987, these important medications have improved the outlook for millions of Americans with heart disease or cardiac risk factors. All in all, statins can reduce the risk of heart attacks and other major clinical manifestations of coronary artery disease (CAD) by up to 37%, with the greatest benefit going to men at the highest risk. And since heart disease is America's leading cause of death, it's no wonder that the seven statin drugs (see Table 1) are the best-selling prescription medications in the United States.

Targeting cholesterol

All seven statin drugs act in the same way, by inhibiting the activity of 5-hydroxy-3-methylglutaryl coenzyme A reductase, a liver enzyme that's better known by its short name HMG-CoA reductase. By either name, it's the key enzyme responsible for cholesterol production. When the enzyme is blocked, liver cells make less cholesterol, and blood levels of LDL ("bad") cholesterol fall. But these drugs have another benefit: as cholesterol production falls, the liver takes up more cholesterol from the blood, so blood levels fall even further. The statins produce only small elevations in HDL ("good") cholesterol, and only atorvastatin and rosuvastatin lower triglycerides, another potentially "bad" lipid, to an important degree.

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