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Medications

Find answers to frequently asked questions about medications, like how they work and possible side effects.

  • What is evolocumab?
  • Evolocumab is a new type of drug that may help reduce low-density lipoprotein (LDL) cholesterol—the “bad” type of cholesterol that increases risk of heart disease. Evolocumab works by blocking a protein that can interfere with the liver’s ability to remove “bad” cholesterol from the blood.
  • What are statins?
  • Statins are drugs used to lower cholesterol. They help lower low-density lipoprotein (LDL or “bad”) cholesterol and raise high-density lipoprotein (HDL or “good”) cholesterol, which can help prevent heart attack and stroke. Statins prevent your body from making new cholesterol and may help reduce the amount of plaque already built up on artery walls.
  • Does vitamin K2 interfere with blood thinners such as clopidogrel (Plavix)? I have read that K2 will interfere with warfarin (Coumadin) but not with Plavix. Is this correct?
  • Your statement is correct. Vitamin K is an essential cofactor for the synthesis of clotting factors. The effect of anticoagulants (blood thinners) like Coumadin is inhibited by intake or supplementation of vitamin K. Plavix, on the other hand, is a compound that inhibits platelet function. Plavix has no known interactions with vitamin K.

    Best regards,

    Simone Musco, MD, FACC

  • What drug, if any, is used to lower LDL when a person has severe reactions to statins?

  • For those who are truly intolerant to statins, options for effective and proven therapy are limited. Firstly, I would encourage you to work with your cardiologist to try some of the newer statins such as pitivastatin or similar and see if these don’t bother you as much. If they do, other options are bile acid sequestrants such as colesevelam, which are sometimes effective. Another option is ezetimibe, a cholesterol absorption inhibitor. The data on this drug is even less strong—it may in fact lower LDL, but may not do much to necessarily improve outcomes.

    Perhaps the best non-statin way to lower your cholesterol is lifestyle. In addition to a minimum of 30 minutes of brisk cardiovascular exercise each day (working hard enough so that you cannot complete a sentence while exercising), eating a more plant-based, or in some cases, a solely plant-based (vegan) diet is the most powerful way to lower your cholesterol and of course your LDL. There is much data showing that a plant-based diet can help to reduce the likelihood of having a coronary event and may even help to halt the progression of atherosclerosis. A great place to get started with exercise is Walk with a Doc, and a great resource for plant-based diets is PCRM’s 21-Day Vegan Kickstart.

    Best regards,

    Andrew M. Freeman, MD, FACC, FACP

  • I recently had some chest pain, so I went to a doctor who happened to be a cardiologist. Because I am overweight and my blood pressure that day was high, the doctor sent me for a nuclear stress test which came out normal. My concern is she prescribed a beta-blocker, nebivolol (Bystolic) 5mg. Do I need to take this medicine? If not, what harm is it doing to my heart?

  • The answer is that it depends. The newest hypertension guidelines recommend treating your blood pressure if it is, on average, higher than 140/90 mmHg.  However, there are cheaper medications with fewer side effects than Bystolic, like ACE inhibitors and hydrochlorothiazide, which could be used to treat your blood pressure. There are some "natural" ways to combat high blood pressure: limit your salt (sodium) intake to no more than 2 grams daily, try to get 150 minutes a week of moderate intensity exercise and 60 minutes of strength training in a week, and work on weight loss. The DASH Diet is a recommended diet to help with weight loss, controlling sodium intake and improving blood pressure. Bystolic is unlikely to be "harming" your heart. It just lowers your heart rate and your blood pressure. You are taking a low dose of it so stopping it abruptly should not be a problem. It, like other beta-blockers, can make you feel sluggish, depressed, tired, and dizzy with position changes.  It is worth discussing your options with your primary care doctor as well as working on therapeutic lifestyle changes to keep your heart healthy.

    Best regards,

    Susan Matulevicius, MD, MSCS, FACC
    UT Southwestern Clinical Heart Center

     

  • What five categories are considered before prescribing medication for atrial fibrillaton (AFib)?
  • Atrial fibrillation is the most common clinical arrhythmia. Approximately 5% of the population ages 60 years and older has it! The most significant risk of atrial fibrillation is stroke, and the first step is deciding what type of anticoagulation (anti-clotting medication) is appropriate for your situation. Aspirin alone may be adequate, but you may require warfarin or one of the novel oral anticoagulants that can be used in place of warfarin. The next issue is to determine how to manage the heart rhythm abnormality itself. 

    A rhythm control strategy is when you are given medication (antiarrhythmics like flecainide, propafenone, amiodarone, sotatol, dofetilide, and dronedarone) to prevent atrial fibrillation from happening. This is ideal for patients with severe symptoms. These medications help maintain a normal rhythm.

    A rate control strategy allows the presence of atrial fibrillation but prevents fast heart rates with medications to slow your heart rate. This is a good option for patients who do not feel their atrial fibrillation. Medications to help slow your heart while you are in atrial fibrillation include beta blockers (e.g., metoprolol, atenolol, and carvedilol), calcium channel blockers (e.g., diltiazem and verapamil), and digoxin.

    Most importantly, be patient with your care provider! Atrial fibrillation will not be fixed (or understood) in a single visit. A medicine that works for one patient may not work for another.

    Best regards,

    Jeffrey L. Williams, MD, MS, FACC, FHRS

  • Why do some women take estrogen during menopause?
  • The estrogen in hormone therapy is used by some postmenopausal women to increase estrogen levels. This helps prevent osteoporosis and perimenopausal symptoms, such as hot flashes and sleep problems.
  • Is estrogen therapy safe?
  • Like all medications, oral estrogen therapy can cause certain side effects such as headaches, nausea, and weight gain. In rare cases, oral estrogen can cause more serious side effects. It’s important to discuss safety concerns with your doctor before taking any drugs.
  • What is a blood thinner?
  • A blood thinner slows down the blood's ability to form clots. This helps prevent clots that can cause life-threatening problems such as stroke, heart attack and pulmonary embolism. These medicines also can keep blood clots from getting bigger. Blood thinner medicines work in different ways to prevent blood clots, but all of them raise the risk of serious bleeding.
  • What is medication adherence?
  • Medication adherence means taking the proper dose of medication at the right time and in the right way for as long as you're supposed to. Taking a medication incorrectly or not at all can render the drug ineffective, or worse, have a negative effect on your health.
  • Why do women take fertility treatments?
  • Women take fertility medication when they have trouble conceiving. These medications can help stimulate ovulation, which increases changes of pregnancy.
  • How do fertility treatments impact heart health in women?
  • Common complications associated with fertility treatments include multiple pregnancy, bleeding or infection, ovarian hyperstimulation syndrome, and premature delivery. Although long-term research on fertility treatments and cardiovascular risk is sparse, research suggests that fertility treatments do not have a negative impact on cardiovascular health.
  • What is an NSAID (non-steroidal anti-inflammatory drug)?
  • NSAIDs are a common type of painkiller used to treat mild to moderate pain or to help relieve symptoms of arthritis. As with all drugs, NSAIDs carry certain risks, and it’s important to check with your doctor before taking NSAIDs, especially for an extended period of time.
  • Do NSAIDs (non-steroidal anti-inflammatory drugs) increase cardiovascular risk?
  • Yes, like all drugs, NSAIDs carry risk of complications. The most common complication from taking NSAIDs is increased risk of bleeding and increased cardiovascular risk. Risk for complications typically increases with higher doses and extended use, so it’s important to talk with your doctor before taking NSAIDs, especially high doses for an extended period of time.
  • What is a generic drug?
  • Generic drugs are essentially copies of brand-name drugs created after the brand’s patent expires. Generics are comparable to brand-drugs, containing the same active ingredients and proven to work just as well as brand-name alternatives.
  • Are generic drugs the same as name-brand drugs?
  • Yes. Generic drugs have the same active ingredients as their brand-name relatives, although they may look slightly different and contain different inactive ingredients. Research shows that generics work just as well as brand-name drugs.
  • What is digoxin?
  • Digoxin (Lanoxin) is a medication that helps strengthen heart muscle contractions, control heart rate and reduce heart failure symptoms. Digoxin is most commonly used to treat heart failure and abnormal heart rhythms (arrhythmias).

  • What is clopidogrel?
  • Clopidogrel (Plavix) is an antiplatelet drug that helps fight the formation of blood clots. Clopidogrel is typically taken by patients with certain heart conditions or patients undergoing heart procedures to reduce risk of stroke and heart attack.
  • Does niacin help reduce cardiovascular risk?
  • Although niacin is commonly used to lower cholesterol and reduce cardiovascular risk, studies have found that in high doses, niacin can actually cause serious complications. If you’re taking niacin or considering taking niacin to reduce cardiovascular risk, it’s important to discuss this decision with your healthcare provider.
  • Are all types of ARBs the same?
  • No. While all ARBs block the chemical angiotensin in the body, they can do this in varying ways. Consequently, some are more effective in treating certain conditions (such as high blood pressure) than others, and health care providers can use this information to decide which drug is best for each individual patient.

  • Are there alternative smoking cessation aids other than varenicline (Chantix)?

  • There are many smoking cessation aids other than Chantix that can help smokers fight nicotine withdrawal and tobacco cravings. Bupropion (Zyban) is another type of prescription drug, normally used to treat depression that helps people stop smoking. There are also various types of nicotine replacement therapy, including patches, inhalers, lozenges, gums and nasal sprays that can help wean smokers off of cigarettes.
  • What are the most common heart attack symptoms in women?
  • The most common symptoms of heart attack in women include discomfort or pressure in the chest; pain in the arms, upper back, neck, jaw or stomach; nausea or vomiting; trouble breathing; breaking out in a cold sweat; dizziness or lightheadedness; inability to sleep; unusual fatigue and clammy skin. However, women may experience all, none, many or just a few of these heart attack symptoms.
  • What if I have tried to learn more about my health but still have trouble understanding?
  • Patients who have trouble understanding their health conditions should ask for help from their health care team, whether it's a doctor, nurse or counselor. Health care providers can help point patients to a variety of resources that can cater to individual needs.
  • What is anticoagulation therapy?

  • Anticoagulant medications are blood thinners that help prevent blood clots from forming around the replacement valve, which can cause heart attack and stroke. Examples of such drugs include warfarin, heparin and aspirin.
  • What is Multaq?

  • Multaq is the brand name for dronedarone, a drug made by the pharmaceutical company Sanofi-Aventis. It was initially approved in July 2009 to reduce the risk of cardiovascular hospitalization in patients with non-permanent atrial fibrillation or atrial flutter with a recent arrhythmic episode and other cardiovascular risk factors.

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