Heart disease is the #1 cause of death and disability throughout the world. In South Africa, 43% of all deaths are due to non-communicable (non-infectious) diseases. 18% of those deaths are due to heart and blood vessel disease. There are many different types of heart disease:
Many forms of heart disease can be prevented and/or treated by living a healthy lifestyle-
Some heart diseases (for example, congenital heart disease) cannot be prevented, and treatment may require surgery to repair heart defects or replace faulty heart valves. Often, a heart attack may require emergency surgery or a procedure called heart catheterization to open up a blocked blood vessel. Arrhythmias and cardiomyopathies may require an internal or external defibrillator to “shock” the heart back into rhythm, or a pacemaker to keep the heart beating regularly. There are many medications that can help to control heart disease symptoms and prevent further heart damage and complications.
Medication treatment for heart disease will depend on the type of heart disease and any other medical conditions you have. There are several newer agents to treat heart disease and related issues that are usually used when other medications aren’t effective. The most commonly used heart disease therapies will be discussed here. You may need to take more than one of these types of medications at one time to provide the best treatment for your heart disease.
Blood Pressure Medications– If your blood pressure is high and you have heart disease, you will likely be prescribed a blood-pressure-lowering medication. High blood pressure can increase stress on the heart, making it work harder to pump blood through your body. It can also increase your risk of heart attack, stroke, coronary artery disease, and heart failure. There are several types of blood pressure medications, some of which have more than one use/purpose in treating heart disease. It is common to need more than one type of blood pressure medication to lower blood pressure to a desirable level in heart disease patients.
–ACE Inhibitors prevent formation of a hormone called Angiotensin in the body, which causes blood vessels to constrict/tighten up. The result is lowered blood pressure because the blood vessels relax. (Examples: lisinopril, benazepril)
–Angiotensin Receptor Blockers (ARBs) lower blood pressure in the same way as ACE inhibitors but block the action of Angiotensin rather than preventing its formation. (Examples: losartan, valsartan)
–Calcium Channel Blockers prevent calcium from entering cells, which makes the heart and blood vessels relax. (Examples: amlodipine, diltiazem, verapamil)
–Beta Blockers slow the heart rate and decrease the force in the heart muscle during a heartbeat, resulting in lower blood pressure. (Examples: metoprolol, carvedilol)
–Diuretics (sometimes called a “fluid pill” or “water pill”) decrease fluid in the body, which lowers blood volume and therefore decreases blood pressure. (Examples: furosemide, hydrochlorothiazide/HCTZ, spironolactone)
–Vasodilators relax blood vessels to decrease blood pressure. (Examples: hydralazine, isosorbide mononitrate)
Diuretics- In addition to lowering blood pressure, diuretics decrease the workload on the heart by decreasing the amount of fluid in the blood/throughout the body. They help remove fluid from the lungs and relieve swelling in the feet/legs due to heart failure.
(Examples: furosemide, hydrochlorothiazide/HCTZ, chlorthalidone, spironolactone, metolazone, bumetanide)
Antiarrhythmics- An arrhythmia is an abnormal rhythm that happens due to a problem with electrical impulses in the heart muscle. It may be an irregular heartbeat (ex- atrial fibrillation/ a fib) or a heartbeat that is too fast (tachycardia) or too slow (bradycardia). Several drug classes are used to treat arrhythmias. Some medications can stop the arrhythmia from occurring and restore a normal heart rhythm (Examples: amiodarone, digoxin, flecainide, dofetilide). Other medications slow the heart rate and/or increase the force of heart muscle contraction so that the arrhythmia is more tolerable. (Examples: calcium channel blockers and beta blockers).
Antiplatelet medications- Antiplatelet medications prevent platelets (the small blood cells that form blood clots) from sticking together to prevent stroke and heart attack. The most well-known antiplatelet drug is aspirin. It is often recommended that patients who are at high risk of stroke or heart attack take low-dose aspirin daily for prevention. Other prescription-only antiplatelet agents are usually used after a stroke or heart attack to prevent re-occurrence. They are also used for a period of time after heart stent placement to prevent clots from forming on the stent. (Examples: clopidogrel, ticlopidine, prasugrel, cilostazol)
Anticoagulants- Also commonly known as “blood thinners,” anticoagulants prevent clot formation, but they work on the proteins in the blood that form clots, rather than on platelets. Anticoagulants are used in some heart arrhythmias and heart valve diseases to prevent clots from forming in the heart and causing a stroke, heart attack, or pulmonary embolism (clot in the lung). Some of these also can break up an existing blood clot. (Examples: warfarin, apixaban, rivaroxaban, heparin, dabigatran)
Cholesterol-lowering medications- Cholesterol is an essential part of the cells and membranes in the body, but a build-up of cholesterol can cause narrowing or blockage of arteries, leading to heart attack and stroke. This is of particular concern for patients with known heart disease, but also in people who are genetically prone to developing high cholesterol. Some cholesterol drugs are known to decrease inflammation that can lead to heart attack and stroke, and may even be used when cholesterol levels in the blood are not excessively high. (Examples: simvastatin, atorvastatin, rosuvastatin, niacin, ezetimibe, fenofibrate, evolocumab)
Direct Vasodilators- In addition to lowering blood pressure, vasodilators relax and open up blood vessels to allow blood to flow more easily through the heart. They are also used for heart failure and to relieve chest pain. (Examples: nitroglycerine, isosorbide mononitrate, isosorbide dinitrate)
There are several common side effects associated with medications for heart disease, and some that, while rare, may require immediate medical attention. Other side effects, while not life-threatening, may require a change in drug therapy.
Common side effects:
Serious side effects:
All of these should be evaluated by a healthcare provider right away.
–Dehydration is a risk associated with diuretic use. While frequent urination is to be expected due to how these medications work, extreme thirst, weakness, excessively dry mouth, eyes, and skin, paleness, and severe constipation can all be signs of dehydration that should be assessed and treated by a medical professional.
–A dry cough can be associated with ACE inhibitor use. While it is not dangerous, if this becomes particularly bothersome (for example, it keeps you awake at night), you should discuss with your doctor, and you will likely be prescribed an alternative.
Heart disease is a serious health issue but can often be managed with medication or a combination of medications. It is important to keep a list of all medications you use, pay attention to the dosage and schedule, and be aware of any new or unusual side effects.