Medications for Heart Disease and Stroke
by Phillip Treadwell, PharmD

The drug treatments for heart disease and strokes are multifactorial. They include therapies for diabetes, high blood pressure and high blood cholesterol. These are discussed in other letters, but it must be remembered that control of these problems, if present, is absolutely necessary to prevention or treatment of heart disease or stroke. Most heart disease and strokes are caused by vascular disease, the narrowing of blood vessels caused by cholesterol filled plaques. The major drugs that are used specifically for heart disease and stroke prevention are the platelet inhibitors and warfarin. Platelets are the cells in the blood that are responsible for clotting. When platelets are inhibited, then clots are less likely to form on plaques in the artery walls. We will take a quick look at these important medicines.

The most commonly used platelet inhibitor to prevent the clots that cause heart attacks and strokes is aspirin. Plain aspirin is more than just a pain reliever. Many studies have shown that it can reduce the risk of heart attacks and stroke. Although aspirin can cause stomach ulcers in some people, the doses that are used for this purpose are much lower than those used for pain. Therefore, it is much safer to use aspirin for vascular disease than it is to use it for a painful condition such as arthritis. Some people are allergic to aspirin and these people must not take aspirin at any dose.

Another platelet inhibitor is clopidogrel (Plavix®). Clopidogrel inhibits platelets by a different mechanism than does aspirin. It has been shown in one study to be better than aspirin for the prevention of problems in people with vascular disease. It is much more expensive than aspirin and may, rarely, cause blood disorders. It also causes more nausea than aspirin, but does not cause as many ulcers. People who are allergic to aspirin can usually take clopidogrel.

Persantinecombined with aspirin is available in the prescription product Aggrenox®. Aggrenox® has been shown in one study to be better at preventing strokes than a low dose of aspirin. It has not been compared to aspirin for heart attack prevention. Aggrenox® shares all of the side effects of aspirin, because it contains aspirin, and costs much more. It may also make asthma worse in some people.

Warfarin(Coumadin®) is a blood thinner that does not work by inhibiting platelets, but instead by altering proteins in the blood that cause clotting. It works by blocking the action of vitamin K. People who take warfarin must be careful to limit vitamin K intake in their diet, and must be especially careful to be consistent with the amount of this vitamin that they eat. Most green, leafy vegetables are high in vitamin K. Click here for more information on this and other vitamins. Another problem with warfarin is that it can cause drug interactions with many other medicines. Consult your pharmacist before adding any medicine, prescription or over-the-counter, to a regimen containing warfarin.

An important thing to remember about all of these medicines is that they can cause excessive bleeding. People who take these products should carry some form of identification showing that they are at increased risk of bleeding. This information can be valuable in an emergency when the person may not be able to speak for himself. Please talk to your physician or pharmacist if you have any questions, but, remember, these medicines save lives when used appropriately.

 

Back to Medications, Supplements, Vitamins, and Minerals

Alcohol & Drugs / Gambling & Financial Wellness / General Wellness Topics / HIV & AIDS /
Minority Health / Nutrition / Peer Health Educators / Sexual Health / Tobacco Use