The Big 6 Heart Medications

What each pill does for you


Physicians today have an arsenal of medications they can prescribe to help their patients in the battle against heart disease. If you are a heart patient, you can expect to be taking one or more of these highly effective medications.

As a heart patient, it’s important to understand what each medication does and how to use them safely, often in combination. When used appropriately and according to the proper prescription, these medications extend both quantity and quality of life by preventing heart attacks and strokes.

Modern heart drug therapy includes the following “big six” medications:

1. Statins — to lower LDL cholesterol

Statins were first introduced in 1987 and doctors now have seven different medications from which to choose depending on a patient’s need. They lower the “bad” LDL cholesterol levels by 20 to 60 percent and also reduce inflammation. Most people who have had a heart attack or stroke, bypass surgery, stents, or diabetes should be taking statins. Some patients with a high LDL level, but without heart disease, should also take statins.

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2. Aspirin — to prevent blood clots


Aspirin has been around for a long time and was first discovered to have cardiovascular benefits in the 1960s. Aspirin can help to keep arteries open because of its anti-clotting and anti-platelet effects. A standard dosage for heart patients is 81 mg a day, which is one baby aspirin. Aspirin makes sense for people who already have heart disease, but not necessarily for people who just have risk factors.

3. Clopidogrel — to prevent blood clots

This drug is considered a “super-aspirin” because of its effectiveness in preventing platelet clumping and it is often used in combination with aspirin. For some patients there is an increased risk of bleeding and doctors will weigh the benefits versus the risks of this drug. However, for patients with stents, the combination of aspirin and clopidogrel is essential to preventing clotting. It is also often used for patients with worsening angina.

4. Warfarin — to prevent blood clots

This drug is a stronger anti-clotting agent than aspirin and clopidogrel. It works as an anticoagulant – or blood thinner. Warfarin is widely used to prevent the formation of clots for patients with atrial fibrillation, those with artificial heart valves and those who have formed blood clots in veins of the legs. Because it interacts with other medications and diet, it requires close monitoring by a physician.

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5. Beta-blockers — to treat heart attack and heart failure and sometimes used to lower blood pressure

Beta-blockers block the effects of adrenaline, which comes on in response to stressful situations. Beta-blockers are prescribed in the treatment of these four conditions—angina, heart attack, congestive heart failure and abnormal heart rhythms. Dosage must be adjusted for the desired response and doctors will monitor for dizziness (due to low heart rate), and kidney and liver problems.

6. ACE inhibitors — to treat heart failure and lower blood pressure

ACE (angiotensin-converting enzyme) inhibitors prevent the body from producing the artery-constricting hormone angiotensin. Arteries relax with ACE inhibitors and this lowers blood pressure. They are prescribed for patients with congestive heart failure, a recent heart attack, and those with hypertension.

Heart 411Collectively, these drugs are saving lives by preventing heart attacks and strokes. Chances are you will take one or more these medications if you are at risk for or have coronary heart disease. Be sure to know your medications and follow your doctor’s instructions. You will want to work with him or her to get the safe and effective combination for you.

The information in this article is summarized from the book Heart 411 by Marc Gillinov, MD, and Steven Nissen, MD, of Cleveland Clinic’s Heart & Vascular Institute.

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  • Jose Carranza

    El Clopidrogel y la Warfarina are not esential if you take ASPIRIN DAILY and at doses of 1 gm or more per day, since not only prevents “blood cloths”, also prevents carcinoma of the colon and prostate. The statins are still questionable, possibly except the one that IS NOT ABSORBED , the other might compromise your liver functioning. If there was a double blind study comparing Clopidrogel with the right amount of aspirin, the results will favor ASPIRIN , and the cost is about one tenth .

  • jerry gates

    what about sodolol? I believe l will be put on it to help prevent atrial fib or flutter. How does it react to warfarin and a beta blocker as well as simvastatin? Thank you

    • The_Beating_Edge_Team

      From our pharmacy: Sotalol is a beta-blocker medication that also has other anti-arrhythmic properties. It treats abnormal heart rhythms in two different ways. There are no interactions with warfarin nor simvastatin, however, since sotalol is in the beta-blocker class, patients typically not continued on a beta-blocker (e.g. metoprolol, carvedilol) as well. betsyRN

  • dtf–Ithaca, NY

    What about Tikosyn for atrial fibrillation? I was put on this (by the Cleveland Clinic!) several months ago and it has worked very well–very little Afib and no side effects that I have noticed.

  • F Williams

    And – what about Calcium Channel Blockers – i.e. diltiazem?

  • Barbara Jones

    What about diuretics?

  • Linda Jean Limes Ellis

    I find nowadays that if I take even an 81 mg aspirin I start to feel light headed and feel like I might pass out. My blood pressure runs around 140/90 which I know is borderline high, but so far I have not been able to find blood pressure medication that I can tolerate to stay on. Tried 5 kinds already. Spent too much money on them and only to learn I cannot stay on them due to leg cramps or lightheadedness. I tried the Ace inhibitors and got real lightheaded from those. Couldn’t even bend down without feeling I might faint.

  • Roberta Gleeson

    I have been taking statins for several years and my LDL is now great, but the HDL is down. What can I do to raise it?

  • The_Beating_Edge_Team

    Many of you are asking about specific very important medications. This was written to cover the most commonly prescribed medications. However, medications are very individualized and prescribed based on the patient’s condition. If you have questions or concerns about your medications, you should talk to your doctor. Your pharmacist is also a great resource for medication information, interactions and side effects. The National Library of Medicine’s Medline Plus also has a Drug Information Section at . Hope this helps! betsyRN

  • Robin Cearnal

    I am on Clopidogrel & a baby aspirin daily. The bruises are horrible. My cardiologist told me to take the Clopidogrel every other day. Has not helped at all and I don’t have another appointment with him until 12/13. When I say something to him about the bruising, he says that tells him it is working. I won’t wear long sleeves, shorts or dresses due to this. Any suggestions?

    • The_Beating_Edge_Team

      Dear Robin, I spoke with Dr. Bartholomew, Head of Vascular Medicine and an expert in blood clotting. He said there can be many reasons for your bruising, such as many older patients get a condition known as senile or simple purpura. The bruises are usually on their arms and/or legs. They can be a result of “thinning skin” as we get older – Or it can be related to other potential causes. Since we do not know your medical history, it is best to have a complete blood count and have your platelets checked. He would recommend you see your primary care doctor or even a hematologist or someone like Dr. Bartholomew at Cleveland Clinic. betsyRN

  • mer661

    what is the best, most popular

    • The_Beating_Edge_Team

      There are many medications to treat cholesterol. It should be a very individualized discussion with your dotor based on your specific goals. The most common medication is a group of medications called “statins,” which are used in combination with a heart healthy diet. betsyRN

  • Grannyscott

    What is the statin least likely to cause leg cramps? I discontinued Lipitor and switched to Crestor for that reason, but after about a year with no problem, am now having bad leg cramps occasionally.

    • The_Beating_Edge_Team

      Sometimes the doctors need to work with patients to find the right drug for them. There is a nice article at that describes what is called “statin intolerance” and what they do to help patients. Let us know if you need more information. betsyRN – go to

      • Darlene

        I also stopped the Lipitor be cause it gave me Restless Legs that kept me awake so I stopped it. Now after a triple by-pass I am on a different
        one Pravastatin it still effects me but I was given a sleeping pill, but the statins give me a creepy crawly feeling. The medical persons do not seem to hear me. I want to get off the merri-go-round.

        • The_Beating_Edge_Team

          Darlene, I would suggest you talk to a Preventive Cardiology team that works as a partner with patients and includes diet, exercise, and tailors medications to meet the needs of the patient. We are happy to help you here or look locally for this type of program. betsyRN

  • Robert H. Cook

    Well you should tell some Dr’s about mixing warfrin with other drugs such as prenisone,because they do it all the time.They cause people a lot of strokes.

    • The_Beating_Edge_Team

      Robert – Tomorrow 5/1, Dr. Bartholomew and Dr. Evans are going to be talking about coumadin and other medications to prevent blood clots if you would like to ask any questions. . betsyRN

  • Susan Bannister

    They used to use a procedure to shock the heart back into rhythm for atrial fibrillation, and my physician said it is not as successful. Is this your belief at the Cleveland Clinic?

    • The_Beating_Edge_Team

      Cardioversion is a procedure in which an electrical shock is delivered to the
      heart to convert an irregular rhythm to a
      normal heart rhythm and it can be successful in some people. It depends on your specific case. Dr. Van Wagoner stated in a recent web chat: “Cardioversion is typically very
      successful acutely. Maintenance of normal sinus rhythm is more challenging and
      may require the future use of antiarrhythmic medications. Anticoagulation is
      typically recommended prior to cardioversion of AF episodes that last >48

  • Barbara Ady

    Does the medicene Digoxin 0.125 cause a person to be sleepy or very tired?

    • The_Beating_Edge_Team

      According to the National Library of Medicine’s MedlinePlus,, Digoxin can cause drowsiness. You should contact your doctor to see if it is the Digoxin or some other cause. Perhaps he can help prescribe a different drug or adjust your dose if it is the digoxin. betsyRN