The heart is the body’s main pump for the movement of blood. It distributes vital blood, oxygen, and nutrients throughout your body. Coronary heart disease occurs when the blood vessels of the heart are damaged or diseased. Coronary heart disease can have many serious consequences. It can lead to a heart attack (myocardial infarction), congestive heart failure, or arrhythmias, all of which can result in death.
In addition to recommending that a person make important lifestyle changes, a doctor may prescribe medications. These medications have several different goals depending upon how heart disease specifically affects a patient’s heart. Many of the drugs prescribed for people with heart disease have been definitively proven to extend people’s lives. So, while some medications may simply help control a symptom or decrease discomfort, other ones will lower the likelihood that a person with coronary artery disease (CAD) will die from their disease. It’s very important that people with CAD take all of their medication exactly as their doctors have prescribed it for them.
Although coronary artery disease always affects the patient’s heart, not all CAD is the same and therefore it’s not all treated in the same way. For example, some patients have trouble with excessive blood clotting while others need to lower their blood pressure. Patients may need to utilize multiple medications to manage their heart disease. Each medication should be taken according to a doctor’s recommendations.
Angiotensin is a hormone that causes the blood vessels to constrict or get smaller. This raises a person’s blood pressure. By reducing angiotensin levels, blood vessels enlarge. Blood flows easier through the enlarged blood vessels, and blood pressure is reduced. A doctor would prescribe an ACE inhibitor for people with high blood pressure or heart failure in which the heart does not pump enough blood to meet the body’s demands. These medications are also vital post-heart attack. This is because they can help prevent a future event and they also help the heart muscle recover from the lack of oxygen during the heart attack. Examples of these medications include benazepril (Lotensin), ramipril (Altacte), and captopril (Capoten).
Unlike ACE inhibitors, ARBs completely block the effects of angiotensin II on the heart. This effect lowers blood pressure. Doctors prescribe this medication to congestive heart failure patients and patients with high blood pressure. ARBs and ACE inhibitors have similar functions and purposes. Studies have shown ACE inhibitors may slow kidney disease progression in patients with type 1 diabetes and kidney disease. ARBs may slow kidney disease progression in patents with type 2 diabetes and kidney disease. Examples of ARBs include losartan (Cozaar) and valsartan (Diovan). Like ACE inhibitors, ARBs have proven highly beneficial in enhancing a patient’s recovery after heart attack.
In coronary artery disease, one of the primary problems is plaque. It can sometimes result in blood clots. If a clot can becomes lodged in a heart vessel, it can partially or completely prevent blood from flowing anywhere past the clot. Any heart muscle that relied on that vessel for oxygen and nutrients will die if blood flow is not restored very quickly. If a blood clot travels to the lungs, a potentially fatal pulmonary embolism can result. If a clot lodges in the brain, a stroke could occur. While anticoagulants don’t break up existing blood clots, they can prevent blood clots from forming. Examples of anticoagulants include enoxaparin. (Lovenox), heparin, and warfarin (Coumadin). Anticoagulants are used to prevent heart attacks and strokes.
Antiplatelet medications are prescribed after a cardiac event like a heart attack. Doctors also prescribe them for people with known plaque buildup in their arteries to prevent heart attacks. People who experience abnormal heart rhythms, such as atrial fibrillation may also take antiplatelets because they are at increased risk for blood clots. Examples of antiplatelets include aspirin, clopidogrel (Plavix), and prasurgel (Effient).
Beta blockers are a broad category of medications to treat coronary heart disease. While they may have some shared purposes, they can work in different ways to prevent arrhythmias. The main purpose of beta blockers is to target the heart’s beta receptors. Beta blockers can control a heart rate to keep it from beating too fast. They have protective effects in preventing heart attack and also preventing a second heart attack in patients who have had heart attacks.
Doctors prescribe beta blockers to treat hypertension, heart failure, chest pain, and arrhythmias. Examples of beta blockers include metoprolol (Lopressor), labetalol (Trandate), and propanolol (Inderal).
Calcium channel blockers can work on different aspects of the body to serve specific purposes based on a person’s unique health condition or conditions. Calcium has several effects on the body. One of them is to trigger heart contractions. By slowing calcium’s rate in triggering these contractions, blood vessels can relax. Blood pressure then lowers. Doctors prescribe calcium channel blockers in patients with hypertension, chest pain and heart arrhythmias. Examples include amlodipine (Norvasc), diltiazem (Cardizem), and nifedipine (Procardia).
Cholesterol buildup in the blood vessels can cause plaque to build up, narrowing blood vessels. This plaque can break off and block the blood vessel, particularly if a blood clot forms around the plaque rupture. Examples of cholesterol-lowering medications include the following. Some of these drugs have also been proven to decrease the risk of death from CAD:
- statins: atorvastatin (Lipitor), pravastatin sodium (Pravachol) and simvastatin (Zocor)
- bile acid resins: cholestyramine (Questran)
- cholesterol absorption inhibitors: ezetimibe (Zetia)
- fibric acid derivatives: fenofibrate (Tricor)
- nicotinic acid: niacin (Niacor, Nicolar)
Digitalis medications work to increase how hard the heart contracts. While these medications are typically prescribed to treat other heart disease types, such as cardiomyopathy, a person with coronary heart disease may take these medications. By pumping harder, the heart can get more blood out in a single beat. Digitalis medications treat patients with heart failure who may not experience benefits from ACE inhibitors and diuretics. These medicines also treat irregular heartbeats, including atrial fibrillation. A medication example is digoxin (Lanoxin).
Nitrates widen blood vessels so blood can pass more easily. Doctors prescribe them to treat chest pain (angina) and reduce heart failure symptoms. Examples of nitrates include nesiritide (Natrecor) and hydralyzine (Apresoline). Nitrates can come as an intravenous (IV) infusion, a cream formulation, a fast acting tablet that goes under the tongue, or a traditional pill form.