What types of drugs are used for treating heart disease?

The most common medicines used for heart disease include:

• Statins (HMG-CoA reductase inhibitors)
• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptors blockers (ARBs)
• Calcium channel blockers (CCBs)
• Beta blockers
• Nitrates
• Antiplatelet Agents
• Anticoagulants

Heart disease often refers to coronary artery disease (atherosclerosis or “hardening of the arteries''). This occurs when plaque (made up of cholesterol) builds up on the wall of the arteries that supply blood and oxygen to the heart (called coronary arteries). This can be life-threatening.

But in the broadest sense, there are many other types of "diseases of the heart”. These include: angina (chest pain), heart failure, arrhythmias (abnormal heart rhythm or rates), heart valve diseases, cardiomyopathy (weakened heart muscle) and congenital heart disease (heart disease present at birth).

Related: Is cardiovascular disease the same as heart disease or coronary heart disease?

The best medicine for your heart disease will depend upon what condition you have, what treatments you have used in the past, and any other medical conditions that may affect your drug therapy. In addition, other factors like drug cost, local availability and personal preferences need to be taken into consideration. In some cases, more than one heart medicine is needed to adequately manage heart disease.

Lifestyle changes are usually used in addition to medications to modify heart disease risk. These changes can include following a low-fat and low-salt diet, getting at least 30 minutes of exercise on most days of the week, weight control, stopping smoking and tobacco use, controlling stress, and low to moderate alcohol use (or none at all).

A list of medications frequently used to treat and help to prevent heart disease include:

Statins

• Statins are a large class of drugs used to help lower LDL cholesterol (often called “bad cholesterol) and elevated HDL cholesterol (“good” cholesterol). Common examples include atorvastatin (Lipitor), simvastatin (Zocor), pravastatin (Pravachol) and rosuvastatin (Crestor).
• These medicines help to reduce plaque build-up in the arteries, lowering the risk of a heart attack or stroke. Most people who have had a heart attack or stroke, heart bypass surgery, a stent, or diabetes should be taking statins.
• Most statins are now approved in a generic version which makes them more affordable.

Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II Receptor Blockers (ARBs)

• ACEs and ARBs are two classes of heart medicines frequently prescribed for high blood pressure. Common examples include the ACEs lisinopril (Prinivil, Zestril) and ramipril (Altace) and the ARBs olmesartan (Benicar) and valsartan (Diovan). They can help to prevent a heart attack, stroke or kidney disease.
• They work by relaxing blood vessels (allowing them to widen). They inhibit enzymes or receptors that can narrow blood vessels and lead to high blood pressure or high kidney pressure.
• They are used in patients with high blood pressure, a recent heart attack, congestive heart failure or to help slow down the progression of kidney disease.
• Many generic options for ACEs and ARBs are available on the market, making them a cost-effective treatment.

Calcium channel blockers (CCBs)

• Calcium channel blockers (CCBs) relax arteries by slowing the entry of calcium into cardiac and smooth muscle cells. Common examples are amlodipine (Norvasc) and diltiazem (Cartia XT).
• This class works to lower blood pressure or heart rate by widening the blood vessels and improving oxygen flow to the heart.
• CCBs are used to treat high blood pressure, angina, arrhythmias, and circulatory disorders, and are typically quite affordable when a generic option is selected.

Beta Blockers

• Beta-adrenergic blocking agents (beta blockers) are another large class of drugs that are prescribed after a heart attack, to treat angina (chest pain), congestive heart failure, to control abnormal heart rhythms, and to reduce high blood pressure.
• Common examples include propranolol, nebivolol (Bystolic), and metoprolol (Toprol XL).
• Beta blockers work by blocking the effects of the hormone adrenaline (epinephrine). They cause the heart to beat more slowly and lower your blood pressure. They also help to improve blood flow through your veins and arteries.
• Generics make this an affordable drug class in most cases.

Nitrates

• Nitrates dilate (open up) the blood vessels, widening them and making it easier for blood and oxygen to flow through.
• Common examples include isosorbide dinitrate (Isordil), isosorbide mononitrate, or nitroglycerin (Nitrostat, Nitrolingual).
• These agents are used in the management of angina, a heart condition where the arteries of the heart are narrowed which can lead to chest pain. These medications are affordable at the pharmacy.

Antiplatelet Agents

• Antiplatelet agents, such as aspirin and clopidogrel (Plavix), help prevent blood clot formation in patients with acute coronary syndrome (ACS) and can help to reduce the risk of having a heart attack or stroke. It may also be used if you previously have had a heart attack or stroke, or have peripheral artery disease (PAD).
• Do not use aspirin for a heart condition unless it has been specifically prescribed by your doctor, as a bleeding risk can occur.
• Clopidogrel and aspirin are both available in generic forms, and are affordable for most patients.

Warfarin or Novel Oral Anticoagulants

• Blood thinners like warfarin or the novel oral anticoagulants are also used to treat and prevent blood clots and stroke. These agents are anticoagulants and do not actually “thin” the blood, but are referred to as “blood thinners.”
• Examples include warfarin, which inhibits the synthesis of vitamin K-dependent clotting factors, and apixaban (Eliquis), and rivaroxaban (Xarelto), which inhibit clotting Factor Xa. They both can increase the risk of dangerous bleeding.
• Warfarin is used to help prevent blood clots in people who have heart valve disease. It is a more complicated regimen as it requires regular laboratory blood work, close monitoring and can have many food and drug interactions.
• Novel oral anticoagulants like apixaban (Eliquis), and rivaroxaban (Xarelto) are usually first choice options for patients with nonvalvular atrial fibrillation, to treat a blood clot, or to prevent blood clots after some types of surgery, like hip or knee replacements. Xarelto is also used with aspirin to lower the risk of stroke, heart attack, or other serious heart problems in people with coronary artery disease (decreased blood flow to the heart) and peripheral artery disease (PAD).
• Warfarin is a very affordable medicine and has been on the market for decades. The novel oral anticoagulants are much more expensive, but your insurance may pay for this medicine or you may be able to get a cost support from the drug manufacturer.

Related Questions

• What are the side effects of beta blockers?
• Is cardiovascular disease the same as heart disease or coronary heart disease?
• Why is physical activity so important in preventing heart disease?