Medications to Prevent Another Heart Attack
In a healthy body, blood flows through the arteries, carrying oxygen to the heart. However, sometimes fat, cholesterol, and other substances can build up in the arteries, causing blockages that reduce or cut off blood flow to the heart. When the heart doesn’t receive the oxygen-rich blood it needs, it gets damaged—otherwise known as a heart attack.
Many different things can raise your risk of a heart attack, including high cholesterol, high blood pressure, diabetes, smoking, drug use, family history, and aging. And having one heart attack significantly raises your risk of having another, which is why it’s so important for heart attack survivors to commit to lowering their other risk factors. Lifestyle changes are key for preventing another heart attack—by eating a balanced diet that’s low in saturated and trans fats, adding exercise to your everyday routine, quitting smoking, and managing stress and depression, your risk of a second heart attack can be lowered. But along with those lifestyle changes, you’ll need to take several medications to keep your heart healthy and stay away from another heart attack.
When you get a cut, platelets in your blood stick to other proteins to form a clot and stop the bleeding. But when you’ve had a heart attack, and especially after you’ve had a stent placed or bypass surgery performed, you don’t want your blood to clot so easily. A stent is a tube placed in your artery to keep it open, and blood clots can block the stent and prevent blood flow from reaching your heart again. Almost always, doctors will have heart attack survivors start taking aspirin every day to “thin” their blood. Known as a blood thinner or an antiplatelet medication, aspirin keeps your blood from clotting, ensuring it flows successfully through your arteries to your heart. When patients have stents placed, they’ll typically also be prescribed another antiplatelet drug like clopidogrel (Plavix), prasugrel (Effient), or ticagrelor (Brilinta). It’s important not to miss any doses of these drugs, because they prevent clots from forming and potentially blocking your new stent.
There are side effects associated with antiplatelet medications. Because your blood is less likely to clot, you can bruise more easily and bleed much more if you injure yourself. Usually, these are not life-threatening problems, but it’s important to be aware of the issue and also let your doctor know about other medications you’re on that could increase your risk of bleeding.
Most people who have a heart attack are placed on medications that lower cholesterol. The most effective cholesterol-lowering drugs are called statins, which studies show can reduce your risk of another heart attack by almost 40%. Usually, after a heart attack, patients will take statins for the rest of their lives. Common statins prescribed today include atorvastatin (Lipitor), fluvastatin (Lescol), rosuvastatin calcium (Crestor), and simvastatin (Zocor).
In most cases, statins work well and patients can tolerate them, but there are two other major risks we want patients to know about. A tiny number of patients on statins develop liver function abnormalities, which is why we test your liver health before starting you on statins, and then follow up four to six weeks later to see if there’s been any change. Some patients who have existing liver problems won’t be able to use this class of medication. Additionally, in very rare cases, patients can develop a condition called rhabdomyolysis, in which skeletal muscle starts to break down. The main presenting symptoms for this condition are severe muscle pain, severe muscle weakness and dark or brown-colored urine or decreased urination. If you’re experiencing these symptoms and you are taking a statin drug, it is important to let your doctor know this immediately.
Patients on statins can get muscle aches and pains that aren’t caused by rhabdomyolysis (and do not have the associated symptoms of profound muscle weakness and discolored urine), and we can often treat this symptom by either lowering the dose or switching to another type of statin. This is also something that you should let your doctor know right away.
Beta blockers are a class of medication that help decrease some of the negative effects of a heart attack, especially if there’s been a lot of damage to the heart muscle. Post-heart attack, the body releases adrenaline-like hormones, which can change or “remodel” the heart muscle. Beta blockers inhibit the effects of these hormones, so the heart stays protected; they also lower blood pressure and heart rate, so the heart doesn’t have to work as hard. The U.S. Food and Drug Administration (FDA) has approved many beta blockers, including acebutolol (Sectral), penbutolol (Levatol), and propranolol (Inderal).
The side effects of beta blockers are typically tolerable. They have the potential to lower your heart rate and blood pressure too much, which is why most people will be started on a low dose of beta blockers and we will increase the dose as needed over time. Additionally, some beta blockers can exacerbate lung problems in patients who have asthma or other airway diseases, so we’ll keep an eye on those symptoms if that’s a risk.
Angiotensin converting enzyme (ACE) inhibitors are another type of medication given after a heart attack. Long-term studies have shown that beta blockers and ACE inhibitors improve outcomes over long periods of time in patients who have had a heart attack. Like beta blockers, ACE inhibitors help decrease remodeling of the heart and block some of the effects of the hormones the body releases during a heart attack. Fortunately, ACE inhibitors don’t often cause side effects, but when they do, patients can experience fatigue, dizziness, dry cough, headaches, and increased potassium levels in the blood. Common ACE inhibitors include benazepril (Lotensin), enalapril (Vasotec), and quinapril (Accupril).
What Patients Should Know
People who’ve just had a heart attack should see their cardiologist within two weeks from discharge from the hospital, and it’s also important for patients to touch base with their doctor as the years go by. Even if it’s been a few years since your heart attack, make an appointment to check in with your cardiologist to make sure everything is as it should be. If you’re experiencing side effects from your medications, be sure to let your doctor know.
Also inform your doctor if you’re having trouble taking your medications as prescribed—it can be really intimidating to take a bunch of new pills, but committing to your treatment regimen is vital for preventing another heart attack. Make sure you stay on top of when you need to request refills so you don’t miss doses, and consider using pill boxes to organize your pills per day. I also recommend my patients set reminders on their smartphones or download apps to help them monitor their medications and make sure they’re taking them correctly and at the right time. It’s important to find a system that works for you so you’re able to recover well and prevent another heart attack in the future.