Cardioprotective drugs aim to increase survival and decrease symptoms of cardio-related issues through primary and secondary risk factor prevention. Blood pressure, lipid management, diabetes mellitus and metabolic syndrome are among the targeted concerns. Apart from pharmaceutical therapy, weight management, an increase in physical activity as well as smoking cessation help in providing a total holistic approach for the patient.
Cardioprotective Drugs – Anti-Platelet Therapy
Aspirin 75mg
- provides an irriversible anti-thrombotic effect that lasts throughout the whole platelet life, which is between 9-10 days
- provides secondary prevention of cardiovascular events (not to be used as primary prevention due to its increased risk of bleeding
Clopidogrel
- provides an anti-thrombotic effect which is similar to Aspirin
- should be given to patients who are allergic to aspirin
- may be combined with Aspirin and administered post coronary stenting or acute coronary syndrome for a year
Prasugrel
- should be given to patients unresponsive to Clopidogrel
Cardioprotective Drugs – Beta-Blockers
- beta-blockers names end with _lol
- reduce blood pressure and oxygen demand by reducing the heart rate and contractility of the heart
- reduce symptoms of angina – unless contraindicated, patients with angina requiring regular symptomatic treatment should be prescribed beta blockers
- possible side effects include bradycardia, worsening of respiratory symptoms such as in asthma and COPD (switching to beta 1 selective agents may help reduce this)
- erectile dysfunction
- rebound angina and an increase in cardiac events may be possible if medication is discontinued abruptly
Cardioprotective Drugs – Calcium Channel Blockers
- improves angina
- non-dihydropyridines such as Verapamil and Diltiazem help lower the heart rate, reducing contractility, heart rate and AV node conduction, but they may worsen heart failure; may cause side-effects such as bradycardia, conduction disturbances and constipation; can be used with beta-blockers in symptomatic patients (but be careful about possible severe bradycardia)
- dihydropyridines, including Nifedipine and Amlodipine, may cause side effects such as headaches, flushing and ankle oedema
Cardioprotective Drugs – ACE Inhibitors
- helps in treating stable angina pectoris as well as related hypertension, diabetes, heart failure, asymptomatic left ventricular dysfunction or MI injury
- may cause a persistent dry cough, causing some patients to have to switch to an ARB instead
- rarely causes angioedema
Cardioprotective Drugs – Nitrates
Short-Acting Nitro Glyceral Spray
- results in vasodilation
- provides pain relief and anti-ischaemia effects
- sublingual Nitro Glyceral spray reduces angina pectoris attacks and may also be used in prophylaxis
- side effects include headache and flushing, as well as possible orthostatic hypotension
- angina unresponsive to nitroglycerin should be assessed as a possible MI or non-cardiac pain
Long-Acting Nitrates
- provides relief for symptomatic angina
- patient tolerance to oral or transdermal nitrates happens fast, thus, nitrate-free intervals are recommended (eg. nitrate patch should be reduced during the night)
- side effects include headache and orthostatic hypotension
Trimatazidine
- anti-angina properties
- side effects include fatigue and drowsiness
Ivabridine
- preserves AV and intraventricular conduction of the myocardium
- slows heart rate
Statins
- used as primary and secondary preventative measures along with healthy lifestyle changes
- lowers lipid levels, inhibiting cellular cholesterol production, reducing LDL cholesterol by up to 40%, thus accounting to a reduction in coronary events
- may increase HDL (the ‘good’ cholesterol)
- reverses endothelial dysfunction, decreases thrombogenicity and reduces inflammation
- stabilise lipid-rich atherosclerotic plaques, making them less vulnerable to become unstable and possible rupture
- should be prescribed for all patients with Ischaemic Heart Disease due to their long-term benefits
- patients with acute coronary syndrome taking statins are less likely to experience a MI or acute arrhythmias
- patients admitted to hospital with acute coronary syndrome should be prescribed statins independently of their LDL level
- side effects may include skeletal muscle damage which may be indicated by symptoms, Creatine Kinase level elevation and possibly rhabdomyolysis
- OTHER LIPID LOWERING DRUGS include Bile Acid Binding Resins, Fibric Acid derivatives, Nicotinic Acid and Ezetimibe
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