Robotic surgery, beating-heart bypasses, implantable devices—they’re cardiac breakthroughs that make headlines, and deservedly so. But you may have to dig a little deeper for news on quieter breakthroughs, the kind that come in a prescription bottle. The fact is, drugs can do a near-miraculous job of helping the heart without leaving scars behind.
The most widely talked about medications are prescribed to control high blood cholesterol levels and high blood pressure. In addition, drugs are available to ease the severity of a heart attack and stroke.
Statins are relatively new drugs touted for their ability to “unclog” arteries and keep blood flowing freely. They work by lowering low-density lipoprotein (LDL) cholesterol (the “bad” kind that sticks to artery walls) while raising high-density lipoprotein (HDL) cholesterol (the “good” kind that scours LDL cholesterol from the arteries). They also are well tolerated, and studies show that side effects are few, even when used long term. Most likely you’ve heard about one or more of the brand-name statins currently available. They include Crestor, Lescol, Lipitor, Mevacor, Pravachol and Zocor.
Under certain circumstances, statins may be combined with other cholesterol medications such as nicotinic acid (niacin) to raise HDL cholesterol. In an extensive study done at Oxford University, this combination raised HDL cholesterol by an average of 25 percent. Statins also may be useful for postmenopausal women with unhealthy cholesterol levels who choose not to use hormone replacement therapy.
Diuretics are sometimes called water pills because they help the kidneys flush excess water and sodium from the body to control blood pressure. Thiazide diuretics are most commonly prescribed for people with hypertension, while so-called loop diuretics are reserved for those with congestive heart failure.
Angiotensin converting enzyme (ACE) inhibitors prevent the formation of a chemical that makes blood vessels narrow. Their newest cousins, the “antagonists,” work by actually shielding blood vessels from this same chemical. Both groups of drugs help to keep the blood vessels wider, so blood pressure stays in check.
Alpha, beta and alpha-beta blockers all are used to treat high blood pressure by reducing nerve impulses to the blood vessels or the heart (both, in the case of the alpha-beta blockers). The result is that blood passes more easily through the vessels and the heart beats more slowly, so blood pressure goes down. Calcium channel blockers have been shown to be even more effective at reducing the progression of atherosclerosis. They decrease the heart’s pumping strength and relax blood vessels. This lowers blood pressure and improves blood circulation in the heart.
Another class of drugs, vasodilators, works directly to open blood vessels by relaxing the muscles in the vessel walls, thereby lowering blood pressure.
Thrombolytic agents are called “clot-busting drugs” because they are given during a heart attack or a stroke to break up clots obstructing blood flow to the heart or brain. As a result, damage to the heart or brain may be minimized or prevented.
To be most effective, these medications must be given immediately after heart attack symptoms begin—ideally, within one hour of the onset of symptoms. In the case of stroke, the clot-buster must be administered within three hours of the stroke’s onset.
Other drugs used to treat heart disease include aspirin (see “More than headache relief”); nitrates, such as nitroglycerin to ease angina; and digitalis, a drug that makes the heart contract harder when its ability to perform on its own is weakened.