Common heart disease medications

Chances are that we have heard our friends and family members talk about someone who has been recently diagnosed or who has been living with heart disease.

This is not uncommon considering that heart disease is the leading cause of death for both men and women in the United States. Heart disease includes a number of conditions related to a narrowed or blocked and hardened blood vessel that can often lead to heart attacks, angina or stroke. The term also includes conditions related to the muscles, rhythm or valves of the heart, such as heart failure, arrhythmia or heart valve disease, respectively.

Physicians prescribe medications based on the nature of the disease. Heart disease can be very complex to manage because, along with diet and exercise, more than one medication is often needed to treat it. For the heart disease patient, adherence to their medication regimen is very important, as each medication has a different purpose. Taking medications as prescribed can slow disease development and improve quality of life. To understand the role of each medication, the following summary addresses the most commonly prescribed drugs to treat heart disease.

Cholesterol is an essential component of the human body. Too little cholesterol can increase the risk of cancer and hormonal imbalances. High cholesterol can increase the risk of heart disease due to plaque buildup in the vessels. Clinicians select high cholesterol treatments based on patients' heart disease risk factors, current guidelines and an assessment of risk versus benefit.

Statins are one class of cholesterol-lowering drugs. Statin therapy is beneficial because it can decrease the rate of death, major adverse heart events and the need for expensive coronary artery procedures, such as angioplasties, stents and bypass surgeries. Furthermore, statins can prevent heart attacks and stroke in high-risk patients.

Statins are classified into high, moderate or low-intensity, depending on the medication and/or dose. Not all patients are candidates for statin therapy. Patients with severe liver disease, women who are pregnant or may become pregnant or who are breastfeeding should not take statins. Statins interact with a number of medications (for example, cyclosporine, digoxin and oral contraceptives, to name a few) and may require a dosage adjustment of the statin or other medication. Currently, there is no evidence of any serious harm or threat to life caused by statin therapy. Rare side effects of statin therapy include muscle pain and damage that can be reversed after stopping therapy. It is important that patients let their doctor or pharmacist know when a new prescription or over-the-counter medication is added to their medication regimen because some statins can interact with other medications. Some of the most common statins are atorvastatin, rosuvastatin, simvastatin and lovastatin.

If a patient is unable to take statin therapy, other cholesterol management therapies include bile acid resins, niacin fibric acid derivatives, omega-3 fatty acids and cholesterol absorption inhibitors. However, these medications are not as effective as statins in lowering cholesterol. The medication chosen depends on the type of cholesterol that needs to be lowered, patient characteristics, previous medication history, current medications and common side effects of that medication.

High blood pressure occurs when the force of pushing blood against blood vessel walls is higher than normal. Long-standing high blood pressure causes the heart to work harder to push blood thoughout the body. Poorly controlled blood pressure can lead to heart failure or having a heart attack or stroke. Controlling blood pressure is the best step in the prevention of heart diseases. The most common medication used to treat high blood pressure includes angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs) and diuretics.

ACEIs and ARBs work to lower blood pressure by causing the blood vessels to open up. This decreases how hard the heart has to work to push blood in the vessels, which then lowers blood pressure. Patients who are pregnant, have a history of ankle swelling with prior use, or with some forms of kidney disease should not be started on these medications. The side effects of ACEIs and ARBs include increased potassium in the blood and fluid buildup in the legs. Some patients experience a bothersome cough from ACEIs. An ARB may be prescribed instead of the ACEI since dry cough is not a potential side effect of this class of medication. Common ACEIs include lisinopril, quinapril, ramipril, enalapril, benazepril, captopril, fosinopril, moexipril, perindopril and trandolapril. ARBs include azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan and valsartan.

Another class of medication that works to lower blood pressure is calcium channel blockers (CCBs). This class of medication works by slowing the movement of calcium into the cells of the heart and blood vessel walls. This makes it easier for the heart to pump blood and widens the blood vessels. In addition, this class of medication can also regulate the rhythm of the heart. Some common side effects of the CCBs are swelling of the ankles, dizziness, headache, feeling tired and a form of gum disease. It is important that patients let their doctor or pharmacist know when new prescriptions or over-the-counter medications are added to their medication regimen because CCBs can interact with other medications. Patients should avoid eating grapefruit or drinking grapefruit juice when prescribed a CCB. Common agents include amlodipine, felodipine, isradipine, nicardipine, nifedipine, nisoldipine, diltiazem and verapamil.

Diuretics help the body remove extra sodium and water. Diuretics, or water pills, are used to decrease blood pressure and to relieve fluid buildup from heart failure. There are multiple types of diuretics that can be prescribed, but the most commonly used to treat high blood pressure are the thiazide-type diuretics. This class cannot be prescribed to patients who have had an allergic skin reaction or more serious allergic reaction (i.e., difficulty breathing) due to a true allergy to sulfonamide drugs. Side effects from thiazide diuretics include an increase in potassium, cholesterol, calcium and sugar in the blood, and a decrease in magnesium and sodium. The most commonly prescribed thiazide diuretics are hydrochlorothiazide and chlorthalidone.

Arrhythmias, or rhythm problems of the heart, can lead to problems with the blood not moving properly across the heart and can lead to the formation of blood clots. These blood clots could cause a heart attack or a stroke. Antiarrhythmics help to slow the electrical activity of the heart to normalize the heart rhythm. There are eight classes of antiarrhythmic medications (Class 0-VII) available, with amiodarone being one of the most commonly prescribed. Common side effects of amiodarone include nausea, vomiting, constipation, abdominal pain, fatigue, headache, trouble sleeping, flushing, changes in taste and/or smell, lack of appetite or increased saliva. Amiodarone also has the potential for multiple drug-drug interactions and, as a result, patients should inform their pharmacist or physician before starting any new medication.

After reviewing some of the most commonly prescribed medications in heart disease, it should not come as a surprise that many patients could quickly become confused about their prescribed medications. A patient will often need to take more than one medication to manage heart disease. Every medication described above has a unique and essential role in significantly decreasing the risks and the progression of heart disease, as well as improving the overall quality of life of patients diagnosed with heart disease. Your physician will balance between benefits of these medications on heart health and the risk of possible medication side effects when choosing to prescribe these medications. Patients with heart disease are encouraged to speak with their pharmacist about any medication concerns. Patients should consult with their pharmacist to understand their medication's purpose, learn how to safely use a newly prescribed medication, discuss possible drug interactions, recognize possible side effects or to address any questions or concerns they have about their medications.

Updated December 2020.