By Megan Sessums, Pharmacist Resident, BHMC-Little Rock
Although the month filled with heart-shaped candy boxes is coming to an end, there is still time to raise awareness about heart disease. February is commonly known as the month of love, but it is also deemed American Heart Month by the American Heart Association.
Heart disease is the leading cause of death among both men and women in the United States, accounting for nearly 600,000 deaths each year.
Heart disease (also called cardiovascular disease) is a general term used to describe a range of conditions that affect your heart and blood vessels. Many factors can put a person at risk for heart disease including high blood pressure, high cholesterol, diabetes, smoking, physical inactivity, unhealthy diet, stress, family history of heart disease, and advanced age.
Unfortunately some risk factors such as age and family history of heart disease, can’t be changed. However slight lifestyle modifications can be made to decrease your risk for cardiovascular disease.
For those individuals who have already been diagnosed with heart disease, adherence to a healthy lifestyle and medication regimen can prevent further advancement of the disease.
There are a variety of heart disease medications that are often prescribed in combination to reduce blood pressure and prevent blood clots. A few classes of these medications include ACE inhibitors, ARBs, diuretics, calcium channel blockers, beta-blockers, anti-platelets, and anticoagulants.
ACE (Angiotensin-Converting Enzyme) inhibitors reduce angiotensin II in the body, which allows the blood vessels to relax and widen. This dilation of the arteries lowers blood pressure and allows the heart to pump blood more easily. These medications end in “-pril” and a few common examples include benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil, Zestril), and ramipril (Altace).
ACE inhibitors are commonly used to treat hypertension and heart failure, to help prevent kidney damage in patients with diabetes, and to prevent further heart damage following a heart attack. The most commonly reported side effect with ACE inhibitors is a dry cough.
ARBs (Angiotensin Receptor Blockers) are similar to ACE inhibitors by working to decrease certain chemicals that narrow the blood vessels, therefore allowing blood to flow more easily through the body and lowering blood pressure.
These medications end in “-sartan” and a few common examples include candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), and valsartan (Diovan). ARBs may be substituted in patients who do not tolerate ACE inhibitors due to side effects.
Diuretics (also known as “water pills”) help the body to get rid of excess fluid and salt, making it easier for the heart to pump while also decreasing swelling. Chlorthalidone (Hygroton), furosemide (Lasix), hydrochlorothiazide (HCTZ), metolazone (Zaroxolyn), and spironolactone (Aldactone) are all examples of diuretics.
Diuretics are most commonly used to treat hypertension and heart failure by lowering the blood pressure and removing excess fluid. Possible side effects of diuretics include low sodium in your blood (hyponatremia), dizziness, headaches, increased thirst, and muscle cramps.
Calcium channel blockers (CCBs) reduce the amount of calcium entering the cells of the heart. As a result, the blood vessels relax and increase the amount of blood and oxygen to the heart reducing blood pressure and lowering heart rate. Examples of calcium channel blockers include amlodipine (Norvasc), nifedipine (Procardia), verapamil (Calan, Verelan), and diltiazem (Cardizem).
CCBs are used to treat high blood pressure, angina (chest pain), and irregular heart rhythms (such as atrial fibrillation and paroxysmal supraventricular tachycardia). The most common side effects of CCBs are constipation, headache, rash, edema (swelling of the legs and feet), and dizziness.
Beta-blockers work by blocking the effects of the hormone epinephrine (also known as adrenaline), therefore allowing the heart to beat with less force and reducing blood pressure. These medications end in “-lol” and include atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol XL), propranolol (Inderal), and nebivolol (Bystolic).
Beta-blockers can be used for treating high blood pressure, heart failure, angina, irregular heart rhythms, and even migraines. Possible beta-blocker side effects include fatigue, upset stomach, decreased libido, and headache.
Antiplatelet agents such as aspirin, clopidogrel (Plavix), prasugrel (Effient), and ticagrelor (Brilinta) prevent platelets from sticking together and forming blood clots.
Aspirin is commonly prescribed to prevent stroke and heart attacks. Even though it is available without a prescription, it is just as important as any other medicine your doctor prescribes. Antiplatelet medications should not be confused with anticoagulants, which keep the blood from clotting.
Anticoagulants work by blocking factors in the blood, which are needed to stop bleeding. Warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis) are all examples of anticoagulants.
Anticoagulants are commonly prescribed to prevent stroke in patients with atrial fibrillation. They are also used to treat patients who have developed a blood clot in their leg (deep vein thrombosis) or lung (pulmonary embolism). Side effects may include excessive bruising, bleeding of the gums, nosebleeds, headache, and fatigue.
The good news for those who have been diagnosed or are at risk for heart disease is that the above medication classes are available to prevent disease progression.