Drug Treatment of Cardiovascular and Vascular Disorders
There are several lifestyle changes that are the first line of defense against cardiovascular disease. These include adopting a diet low in saturated fat and cholesterol, quitting smoking, and beginning a regular exercise program. If these fail, or are insufficient, drug treatment is often the next treatment option.
There are several categories of drugs used in the prevention and treatment of cardiovascular disease. The regimen chosen for a particular patient depends on the nature of their cardiovascular problem and any other medical conditions they may have.
Often, treatment for elevated serum cholesterol is administered as a preventative, before a patient ever exhibits symptoms of heart disease. The ability to reduce cholesterol via drug therapy is an important adjunct to lifestyle changes, and can be of great benefit when such changes by themselves are insufficient. However, such a step must be carefully considered, because the medication is taken long term, and may have significant side effects.
One of the most effective categories of cholesterol medications is a class of drugs called statins. They block the action of an enzyme called HMG-COA reductase, which causes the liver to produce less cholesterol itself and absorb more low-density lipoprotein (commonly known as "bad" cholesterol) from the bloodstream.
High blood pressure, or hypertension, is another cardiovascular risk factor that often responds to drug treatment. As with elevated cholesterol, lifestyle changes are generally tried first. Many patients with hypertension respond to a low-salt diet, in addition to the low-fat diet and exercise recommendations generally cited for maintaining a healthy heart.
Diuretics, or "water pills," were the earliest drug treatment for hypertension, and have been administered for more than 40 years. They cause the kidney to excrete more water and sodium, reducing the volume of the blood. High blood pressure may also be treated with beta blockers, which slow down the heart to reduce the blood volume it pumps out. Another class of drugs for hypertension are the vasodilators, which relax the blood vessels, or prevent them from constricting, so the blood can pass through more easily. These include the angiotension-converting enzyme or ACE inhibitors, the alpha blockers, and the calcium channel blockers.
Some of the oldest vasodilators, the nitrate drugs, may be used to relieve angina. Angina is a common cardiovascular problem, caused by arteriosclerosis or arterial spasm. Nitrates, administered in a quickly-absorbed form by means of a tablet placed under the tongue, can give fast relief.
A type of cardiovascular drug with an even longer pedigree is digitalis and its derivatives. Digitalis comes from the foxglove plant, which had been used in herbal medicine for hundreds of years. It is prescribed for a weakened heart, and strengthens its contractions by regulating the amount of calcium and electrical activity in the heart muscle.
Drugs work to correct irregular heartbeats are called antiarrhythmics. These are powerful medications, and must be carefully administered, since an overdose or skipped dose can be dangerous. Antiarrythmics may interact with each other and with other drugs, so they are often first given in a hospital. Regular follow-up is also essential, since a patient's response to the drugs may change over time.
Another important class of drugs prescribed for heart patients includes anticoagulants, antiplatelets, and thrombolytics. These drugs are commonly called "blood thinners." However, they work not by actually diluting the blood but by inhibiting its ability to clot. Anticoagulants are commonly used for patients who with certain arrhythmias, phlebitis, or who have had valve replacements. Aspirin is often recommended to help prevent heart attacks, or for patients who are recovering from a heart attack. It works by interfering with the blood component called platelets, which are instrumental in blood clotting.
Thrombolytics, or "clotbusters," are a relatively new class of drugs that can dissolve clots that have already formed, but before they do any permanent damage. Thrombolytics are administered by emergency medical personnel during the course of a heart attack or stroke, and can significantly reduce the likelihood of disability or death.
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