By Liz DeMarco, PharmD
As a pharmacist in the intensive care unit at Shore Medical Center, I witness firsthand the profound impact that cardiovascular disease and heart failure have on patients and their loved ones every day – but I also have the opportunity to help them live a longer and healthier life through medication. When taken as directed, heart medications can significantly reduce the risk of life-threatening complications of heart disease such as strokes, heart attacks and kidney disease. Yet, despite their critical role, over 60 percent of patients with cardiovascular disease do not take their medication as directed.
At Shore, I work closely with providers to optimize patients’ heart medication regimens, and educate patients and their families on the purpose and importance of their heart medications along with possible side effects, so they know what to expect when they go home. In this article, I explain some of the most common heart medications and offer tips to help you be successful in taking them.
Understanding Your Heart Medications
Because different medications work on different pathways in your body, you may need more than one medication for your heart condition. Be sure to ask your pharmacist questions you may have to help understand the purpose of each of your heart medications.
- Antiplatelets (aspirin, clopidogrel): Antiplatelet medications help prevent blood clots in patients who have had a heart attack, strokes, and other forms of heart disease. Antiplatelet medications can interact with certain medications and increase the risk of excessive bleeding, so always make sure your pharmacist and healthcare provider know about all the medications you take, including over-the-counter medications, vitamins, and supplements.
- Beta blockers (metoprolol, carvedilol): Beta blockers slow the heart rate and force of contraction. This lowers blood pressure and makes the heart beat more slowly and with less force. Beta blockers are used for heart failure, abnormal heart rhythms, and high blood pressure. They improve the life expectancy of patients with certain heart conditions and are used to prevent future heart attacks in patients who have had a heart attack.
- ACE inhibitors (Lisinopril, enalapril, ramipril): ACE inhibitors lower blood pressure by widening blood vessels to reduce the workload of the heart. They are used for high blood pressure and heart failure. If you develop a dry cough when starting an ACE inhibitor, it may go away with time or may require a change in dose. Always inform your pharmacist or healthcare provider if you develop a dry cough.
- Diuretics (“water pills”) (furosemide, spironolactone): Diuretics help the body get rid of excess fluids and sodium through urination. Your diuretic may help lower your blood pressure and reduce swelling from excess fluid in the body. Your provider will monitor your electrolytes closely. Notify your pharmacist or healthcare provider if you experience any significant, sudden changes in weight.
- SGLT-2 inhibitors (dapagliflozin, empagliflozin): If you look online, you may read that SGLT-2 inhibitors are diabetes medications. Although they were first developed for type 2 diabetes, SGLT-2 inhibitors are valuable heart medications, too (even in patients without diabetes). Studies have shown they have significant benefits for heart health.
- Statins (atorvastatin, rosuvastatin): Statins reduce the amount of cholesterol made by the liver and help the liver remove cholesterol that is already in the blood. You may be on a statin if you have certain risk factors (such as diabetes or high blood pressure) to prevent a future heart attack or stroke.
Always talk to your pharmacist or provider about any side effects that you experience. Be mindful of any dizziness when you first start a heart medication that lowers your blood pressure. Sit up slowly and ask for assistance when needed. Some medications such as diuretics and SGLT-2 inhibitors can cause increased urination, so be mindful of how to stay hydrated. It’s important to drink enough water, but not too much. If you do experience a side effect, you may need an adjustment in your regimen. Never stop your heart medications on your own without talking to your healthcare professional.
Medication Adherence
There are a few reasons patients may not take their medication as directed. They may forget, be unsure if it’s working or fear side effects. Your health care providers put together a heart medication regimen to help improve your heart health, protect against long term complications and prevent hospitalizations. It is important to always take your heart medications as directed, even if you don’t have any symptoms. Untreated heart disease can cause damage to your circulatory system and is a contributing factor for heart attack, stroke, and other health threats.
To be successful in adhering to your medications, ask questions so you understand what each medication is for, how to take it, and possible side effects to look out for. Then, set up a system to take your medications regularly. A pillbox is a great tool that can be used to keep track of your medication regimen. Pharmacies sell a variety of pillboxes, so you can pick one that works best for you. Get into a routine and take your medication at the same time every day.
Cost can sometimes be a barrier to adherence if a medication has a significant copay or isn’t covered by insurance. If a medication has a significant out-of-pocket cost, talk to your pharmacist about available prescription programs they may offer to help mitigate financial burden.
Taking Charge of Your Heart Health
If you have heart disease or you are at risk of developing it, one of the most important things you can do is adhere to your heart medications. You play a key role in developing your heart medication plan. To get the most benefit from your heart medications, take them exactly as prescribed. Making informed decisions and keeping adherent to your heart medications is essential for your heart health. Your pharmacist is a great resource for any questions or concerns you may have.
