Heart Medications Archive


Are the new blood thinners better than warfarin (Coumadin)?

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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.

If you have diabetes, a crop of new medicines may help your heart

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.

Target heart rate on a beta blocker

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.

Dealing with the discomfort of 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.

The state of statin prescribing: Location matters

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.

Managing atrial fibrillation: An update

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.

New nasal spray may stop rapid heart rhythm

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.

Ask the doctor: Should I continue aspirin therapy if I do not have heart problems?

Aspirin therapy can help prevent a second heart attack and stroke, but for otherwise healthy older men, its use depends on their 10-year risk for a heart attack or stroke as determined by their doctor. 

Diuretic blood pressure drug linked to fewer hip fractures

In a large, long-term clinical trial, people taking the diuretic chlorthalidone had significantly fewer hip fractures than those taking the calcium-channel blocker amlodipine or the ACE inhibitor lisinopril.

Afib stroke prevention: Go set a Watchman?

Most people with atrial fibrillation take anti-clotting drugs to prevent strokes. For those who cannot take these drugs because of a high risk of bleeding, a tiny, basket-like device implanted in the part of the heart that traps clots may be an alternative. 

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