The Big 6 Heart Medications

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 for you 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% 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.

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 your 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.

But cardiologist Leslie Cho, MD, advises “we should emphasize that it’s really not recommended for primary prevention unless the ischemic benefit outweighs the bleeding risk.”

3. Clopidogrel — to prevent blood clots

This drug is considered a “super-aspirin” because of its effectiveness in preventing platelet clumping, and it’s 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, if you have a stent, the combination of aspirin and clopidogrel is essential to preventing clotting. It’s also often used for patients with worsening angina.

Dr. Cho says if you’ve had acute coronary syndrome, a better option might be Ticagrelor or Prasugrel, however.

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 was widely used in the past to prevent the formation of clots if you have atrial fibrillation, an artificial heart valve or if you have blood clots in your legs.

Dr. Cho says now Warfarin is no longer the first line medication choice for afib or a blood clot in the leg or lungs. It’s primarily used for heart valve disease. And because it interacts with other medications and diet, it requires close monitoring by a physician.

“The first line drug for afib (depending on renal function) is novel oral anticoagulants,” she says.

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.
• Abnormal heart rhythms.

Dosage of these medications must be adjusted for the desired response. Your doctor will monitor you for dizziness (due to low heart rate) 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.

Collectively, these drugs save lives by preventing heart attacks and strokes. Chances are you will take one or more of 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’ll want to work with them to get the safe and effective combination for you.