What's in Your Medicine Cabinet?
Heartmail
NOVEMBER 12, 2019
BIDMC cardiologists discuss the latest updates on low-dose aspirin, statins and blood pressure medications
It can be hard to stay on top of all the latest information available about your heart medications. We talked with cardiologists and pharmacists from Beth Israel Deaconess Medical Center's CardioVascular Institute to help sort through rapidly changing recommendations.
One piece of advice that never changes: Your health care providers are your best source of information. Always talk with them before making any alterations to your routine or stopping any of your medications.
1. Do I need to switch my blood pressure medication?
You may have heard news reports that the U.S. Food and Drug Administration (FDA) has recently taken certain blood pressure medications off the market because some batches contained contaminants that pose a small risk of cancer. The affected drugs are in a class called angiotensin II receptor blockers (ARBs) and include losartan (Cozaar), valsartan (Diovan, Prexxartan) and irbesartan (Avapro).
What should you do if you are taking an ARB?
Patients should first contact their pharmacies to find out if their prescription was from any of the batches impacted by the recall, says Eli Gelfand, MD, Section Chief of General Cardiology at BIDMC. If it wasn't, then you can safely continue to take your blood pressure prescription. If it was part of the recall, contact your doctor.
"There are many different classes of drugs available to treat high blood pressure, and your doctor can work with you to decide which medication you should take," he says. "Often, there are medications in the same class, which your doctor can suggest."
Gelfand emphasizes that patients should never stop taking any medication without first consulting their health care providers. "Abruptly stopping any medication could lead to serious problems."
2. Is taking a daily low-dose aspirin a good idea?
Patients who have had a prior heart attack or certain types of stroke, or who have undergone bypass surgery or had stents put in, are often advised to take a daily low-dose baby aspirin to help prevent the development of blood clots and reduce the risk of heart attack or stroke, says Michael Gavin, MD, MPH, Director of BIDMC's Cardiac Direct Access (CDAC) Unit.
However, among patients over 70 without a history of coronary artery disease or stroke, daily use of aspirin is generally not advised. A recent aspirin study from BIDMC has found that a substantial number of patients are taking low-dose aspirin, many without their doctors' advice.
"Healthy people with no history of heart disease, particularly older adults at an increased risk of bleeding, generally don't benefit from a daily aspirin," says Gavin. "That said, an individual's risk profile, including family history, blood pressure and cholesterol levels, might lead your doctor to recommend you take low-dose aspirin. Patients who are currently taking daily aspirin should talk with their doctors about stopping and those not currently taking aspirin should talk with their doctors before starting a daily regimen."
3. Do statins always cause muscle cramps?
When it comes to lowering cholesterol, statins have a long, successful track record. But they also have an image problem that makes some patients reluctant to take the medication.
"Statins can help lower 'bad' LDL cholesterol by as much as 30 to 60 percent, which reduces patients' risks of heart attack and stroke," explains Mark Benson, MD, Director of Preventive Cardiology at BIDMC.
Popular statins include atorvastatin (Lipitor), rosuvastatin (Crestor), pravastatin (Pravachol) and simvastatin (Zocor).
However, a recent survey found that more than a quarter of people who could benefit from statins aren't using them, in part because they fear side effects including painful muscle cramps.
"It's true that approximately 20 percent of patients taking statins may experience some muscle pain," says Benson. "But this pain is often mild and will usually go away after a week or two. I advise patients to give statins a chance."
If side effects don't go away and symptoms are disrupting a patient's quality of life, Benson notes that there are other options available to manage cholesterol.