Heart Medications Archive

Articles

"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.

Aspirin and your heart: Many questions, some answers

Taking an aspirin can protect you from heart attack, blood clots and more

First marketed by the Bayer Company in 1897, aspirin (acetylsalicylic acid) is one of our oldest modern medications — and its parent compound is much older still, since Hippocrates and the ancient Egyptians used willow bark, which contains salicylates, to treat fever and pain. Over the past 100 years, aspirin has made its way into nearly every medicine chest in America. Indeed, this old drug is still widely recommended to control fever, headaches, arthritis, and pain.

Although aspirin remains an excellent medication for fever and pain, other drugs can fill these roles equally well. But aspirin has a unique role that was not even suspected by its early advocates. In patients with coronary artery disease, aspirin prevents heart attacks.

Ask the doctor: Does pomelo juice affect drugs the same way grapefruit juice does?

Q. I avoid grapefruit juice because my doctor says it affects how my body handles the Lipitor I take for my cholesterol. Should I also stay away from pomelo?

A. The pomelo (also called shaddock, pumelo, pommelo, and Chinese grapefruit) is the largest citrus fruit, ranging from the size of a cantaloupe to that of a large watermelon. Botanists believe that crosses between pomelo and wild orange created grapefruit. Pomelo mixes the sweet taste of orange with the tang of lemon. Its lineage means that pomelo contains many of the same compounds as grapefruit.

The Healthy Heart: Preventing, detecting, and treating coronary artery disease

Medications for heart disease

Although lifestyle changes are an essential first step in treating coronary artery disease, you may need to take medications to reach your cholesterol and blood pressure goals and otherwise reduce your risk. In fact, most people with heart disease need to take more than one medication. The specific combination of drugs will depend on your particular symptoms and risk factors. Some of the most commonly prescribed medications are described below.

Blood pressure medications

For many years, doctors used diuretics — sometimes known as water pills — to treat high blood pressure. Although diuretics remain a mainstay of blood pressure treatment because they are cheap and effective, a flood of other drugs have become available since the 1980s. In addition, a large meta-analysis comparing the various options concluded that the five categories of drugs currently available are equally effective for most people. Work with your doctor to determine the best type of medication for you.

CHAPTER 1: Understanding Cholesterol: The Good, the Bad, and the Necessary

Excerpted from The Harvard Medical School Guide to Lowering Your Cholesterol

By Mason W. Freeman, M.D. with Christine Junge

Reprinted by permission of the McGraw-Hill Companies; © Copyright 2005 by President and Fellows of Harvard College. All Rights Reserved.

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