Despite claims of tremendous strides made in cardiac treatment, supposedly sophisticated breakthroughs in prevention and a great deal of self-congratulation, the sobering fact is that cardiovascular disease (CVD), an umbrella term that includes coronary artery disease (CAD), heart attack, angina, heart failure and stroke, is responsible for nearly one-third of all deaths, killing one person every 37 seconds in the US alone. With statistics like these, small wonder that medicine has thrown its entire arsenal at heart disease, from miracle surgery like open-heart bypass surgery to the latest in highly targeted pharmaceutical combos.
However, one of the least known facts is that many heart drugs actually cause or worsen heart disease. Here's a roundup of the biggest culprits-and what you can do instead. Like heart attack and angina, the medical treatment of hypertension involves a vast litany of drugs that rarely help a condition that can often be resolved by judicious diet and exercise.
Needless to say, with an issue like heart disease, even if you prefer not to take your doctor's advice, you should be working with a qualified, experienced health practitioner who can offer you the appropriate guidance.
With both antiarrhythmic and antihypertensive actions, these drugs only reduce the possibility of a further heart attack by a very small margin, while causing other undesirable side effects such as dizziness, impotence, nausea, cold extremities, nightmares and insomnia. The latest evidence from the New York University School of Medicine, which tracked over 40,000 heart-disease patients for more than three years, discovered that the drugs don't protect heart patients. Those taking the drugs are just as likely as those not taking the drugs to have a second heart attack or stroke. In fact, in those with heart-disease risk factors, there were more heart disease-related deaths when taking beta-blockers.
Beta-blockers can also bring about sudden irregular or abnormal heartbeats (arrhythmias) that can be fatal, without warning.
This family of antihypertensive drugs, including verapamil, diltiazem and nifedipine, can also stop blood from coagulating (clotting). The US Food and Drug Administration (FDA) has cautioned against using nifedipine, as this agent has been shown to first create a sharp drop, followed five hours later by a marked rise, in blood pressure, thus increasing the risk of heart attack.
These drugs can cause the very problem they're trying to treat. In one large trial, there were significant numbers of deaths with encainide and flecainide. Almost 6 per cent of patients died of arrhythmias while taking these drugs compared with 2 per cent with a placebo. Similarly, around 2 per cent died of a heart attack or heart failure compared with 0.7 per cent in the placebo group.
Those not taking the prescribed drugs also had better survival rates after heart-related incidents.
Another trial of an antiarrhythmic agent-a potassium-channel blocker with minimal beta-blocking effects-was stopped early because the death rate due to arrhythmias was unacceptably high.
The editorial accompanying the report of this halted trial concluded that all antiarrhythmic drugs may be considered potentially lethal.
This agent, the main ingredient in dynamite, has been routinely given to hospital patients with chest pain (angina pectoris) since 1867, but has never been tested for safety. When researchers at Stanford University School of Medicine finally did so in a rat model, they found that the drug increased the risk of heart attack, especially when given continuously by intravenous drip.
It damages heart tissue and suppresses aldehyde dehydrogenase 2 (ALDH2), an enzyme that mops up free radicals and protects the heart against injury when blood flow is restricted-such as during a heart attack. In general, the drug doubled the size of the myocardial infarct after being given continuously for 16 hours.
One of the most commonly prescribed drugs for heart failure is digitalis (digoxin), derived from the foxglove plant, even though its long-term benefits and safety have never been established. The latest evidence had shown that it may protect against death in those who are already at high risk because of chronic heart failure.
Its active ingredient is found in around 40 prescription drugs, and the latest evidence shows that it increases heart risk-albeit only in people who have had systolic heart failure. Digoxin is derived from digitalis, used for more than 200 years to treat heart failure. Despite this long-term use, researchers have only recently discovered it can be fatal.
Indeed, after all these centuries of use, the Digitalis Investigation Group thought it was about time to do a proper investigation. They gave 3,397 heart patients 0.25 mg/day of digoxin and 3,403 patients a placebo; all participants were also given diuretics and ACE inhibitors. After an average of 37 months, there were 1,016 heart-related deaths with digoxin and 1,004 with the placebo. The only crumb of comfort was that those taking the drug had 3 per cent fewer hospitalizations.
A study by Kaiser Permanente Northern California also found higher death rates in both men and women whose systolic heart failure-where the left ventricle becomes enlarged, thin-walled and floppy, and so unable to pump blood properly-had been treated with digoxin for two and a half years.
Drugs for hypertension
Whether your blood pressure reading was faulty or just wrong, any 'abnormal' result-and especially any level above 140/90 mmHg-will almost inevitably trigger a prescription for an antihypertensive drug.
Beta-blockers, diuretics, reserpine, methyldopa and clonidine are usually prescribed for hypertension, yet all have been implicated in various other disorders, including depression, impotence and sexual dysfunction, loss of appetite, nausea and tiredness. One particularly worrisome effect is hypotension-a sudden drop in blood pressure on standing-which can cause dizziness and falls. Given this risk factor, it's not surprising that hypertensive drugs are a major cause of hip fractures among senior citizens.
But some blood-pressure drugs can actually exacerbate the condition, while others may even kill you. A study of 2,000 patients with high blood pressure from 13 general practices across England revealed that only just over half of those taking antihypertensive drugs had achieved moderately healthy blood pressure levels, and even the modest goal set by the US Third National Health and Nutrition Examination Survey (NHANES III) of less than 140/90 mmHg was reached by only 27 per cent of patients, despite drugs.
Excluding the US, a survey of more than 18,000 patients in 26 countries worldwide found that only a third of patients managed to achieve the blood pressure targets set by their doctors.
European 'best-practice' guidelines recommend that "more than one drug is needed" particularly for patients with high-normal blood pressure and a history of cerebrovascular, cardiovascular or peripheral artery disease.
The three most common two-drug therapies combine a diuretic with a calcium-channel blocker, beta-blocker, ACE inhibitor or ARB (angiotensin II receptor blocker). But the combination of a diuretic and calcium blocker can dramatically increase the risk of a heart attack. In a study of more than 300 hypertensive patients, taking a calcium-channel blocker with or without a diuretic increased their risk of heart attack by 60 per cent.
A similar rate was seen in patients taking a calcium blocker compared with a beta-blocker. In yet another study, researchers from the University of Washington in Seattle estimated that the risk was even higher: taking a calcium-channel blocker with a diuretic nearly doubled the likelihood of a heart attack.
Beta-blockers are hardly any better. They increase the risk of stroke and don't lower blood pressure, according to a major review of studies involving more than 100,000 patients. In the UK, the British Hypertension Society was so concerned by these findings that it changed its 'best-practice' guidelines in 2006, removing beta-blockers as a first-line treatment for hypertension, even though these drugs are still regularly used as such elsewhere in the world.
ACE inhibitors are generally not well tolerated and cause a range of heart-related side effects-including hypotension (too-low blood pressure) and heart attack.
And while ARBs were designed as safer alternatives, studies suggest they're every bit as dangerous as ACE inhibitors. Valsartan can increase the risk of heart attack by 19 per cent, while candesartan, another ARB, caused a 36 per cent rise in heart attacks.
And despite spending $26 billion a year on drugs with a dubious safety record- and which may not even work very well-doctors could instead prescribe the old-fashioned diuretics and get the same results, but without the added risks. When 42 studies involving nearly 200,000 patients with high blood pressure were analyzed, low-dose diuretics worked just as well as any of the newer agents.
Other evidence for beta-blockers suggests they can be a killer. Their potential for harm came to light only after they were being given regularly to all patients undergoing surgery-including non-heart surgery-to reduce stress on the heart.
The practice, adopted across Europe in 2009, was based on fabricated data and research. The falsifications, perpetrated by Don Poldermans, formerly professor of cardiology at the Erasmus Medical Centre in Rotterdam and former chairman of the European Society of Cardiology (ESC) guidelines committee, were uncovered in 2011.
In the two intervening years, hospital surgical patients were 27 per cent more likely to die from any cause within 30 days, while the risk of stroke or hypotension was increased with a beta-blocker, according to researchers from Imperial College London.
Two of the study's authors, cardiology professor Darrel Francis and research fellow in cardiology Graham Cole, estimated that the practice killed some 800,000 people across Europe, including 10,000 Brits, prompting headlines in The Sunday Times (26 January 2014).
Drugs for stroke
Much of the research on drugs for stroke is focused on finding the single most effective preventative, the most popular options being anticoagulants, antiplatelets, antihypertensives, diuretics and surgery. Typically, treatment ends up being a combination of any or all of these. When thrombolysis-the use of drugs to dissolve blood clots-is performed after cerebral infarction, the likely result is another stroke-this time caused by cerebral haemorrhage.
Warfarin, a commonly used blood-thinning drug, doubles the risk of stroke within the first seven days of use. People with irregular heartbeats (arrhythmias) are at special risk, with a 2.3 times greater chance of stroke by usually the third day after starting the drug.
The risk continues over the first month, but is lower after the first week, say researchers at McGill University in Montreal, who made the discovery after looking at more than 70,000 people taking the anticoagulant. Of these, 5,519 people, or 2 per cent, suffered a stroke after beginning treatment. Although the drug stops blood from clotting by suppressing the body's production of vitamin K, the researchers believe it may have a contrary effect in the first few days by actually making the blood 'stickier'.
In people with arrhythmias, the heart doesn't pump efficiently, making the blood more likely to clot in any case, and warfarin only seems to make it worse; clots that break away and travel to the brain can then cause stroke. Other evidence suggests it could be causing excessive bleeding in patients with atrial fibrillation, the other class of patients prescribed this drug.
Heparin and warfarin are both indicated for cerebral haemorrhage, but there's an ongoing debate over the use of agents like streptokinase (SK) and rt-PA. In fact, three large SK trials were terminated early because of high death rates due to intracerebral haemorrhage.
Thrombolysis is a high-risk strategy for stroke, especially if administered 'late' (three to six hours after the event). The National Institutes of Neurological Disorders and Stroke (NINDS) trial showed an even smaller 'therapeutic window' (less than three hours) for the administration of rt-PA.
The Multicentre Acute Stroke Trial-Italy (MAST-I) was one of those abandoned due to high death rates. Risk of mortality significantly increased more than threefold in those taking SK plus aspirin.
The MAST-I results were clearly not unique, and the effects of different thrombolytic drugs may vary depending on the drug and how it's given. As always, it's the elderly-the majority of stroke patients-who are more likely to suffer cerebral haemorrhage and die as a result.
So the drugs don't work . . .
A number of studies show that heart patients taking various heart drugs do as well as or worse than those taking a placebo, or dummy pill.
Almost 6 per cent of patients died of arrhythmias while taking these drugs compared with 2 per cent who'd taken a placebo. And 2 per cent died of a heart attack or heart failure compared with 0.7 per cent in the placebo group.
Researchers gave more than 3,000 heart patients digoxin and about the same number a placebo; all participants were also given diuretics and ACE inhibitors. After more than three years, about the same number of patients who'd taken digoxin died of heart-related deaths as those taking a placebo.
Of 2,000 UK patients with high blood pressure, just over half of those taking antihypertensive drugs achieved moderately healthy blood-pressure levels. In the US, only 27 per cent managed to reach the new relaxed threshold of 140/90 mmHg. Only a third of patients in 26 countries managed to achieve the blood pressure targets set by their doctor.
Heart drugs: heart dangers at a glance
- Vasodilators: (nitrates, calcium-channel blockers): hypotension (abnormally low blood pressure), potentially fatal heartbeat alterations (either too fast or too slow); sudden rapid heartbeat (with calcium-channel blockers)
- Antihypertensives: (ACE inhibitors, diuretics, potassium-channel blockers): sudden drops in blood pressure, dangerous rises in potassium, fluid in the lungs (when used with some diuretics), heart palpitations
- Beta-blockers: potentially fatally slow heartbeat
- Antiarrhythmics: heart failure, chest pain, choking sensations
- Antiplatelets: (aspirin, anticoagulants): stroke, hypotension.
- Five simple ways to control heart disease
Adopting all five and sticking with them for 20 years or more can control and even reverse the symptoms of coronary artery disease like calcification and thickening of the arteries.
- Keep a healthy body weight.
- Don't smoke.
- Engage in at least 30 minutes of moderate-to-vigorous physical activity five times a week.
- Don't drink more than one alcoholic drink a day if you're a woman, or more than two if you're a man.
- Eat a healthy diet, with lots of fresh fruit and vegetables.
Supplements for a healthy heart
Heart patients are twice as likely to die within a year if their vitamin C levels are low.
Suggested daily dosage: 1-3 g or more (with the guidance of a trained nutritional therapist)
Vitamin A and beta-carotene
The lower your blood levels of these nutrients (as well as other antioxidants like vitamins C and E), the higher your risk of angina, so make sure you're getting enough.
Suggested daily dosages: up to 25,000 IU as beta-carotene or 10,000 IU as retinol; 1-3 g of vitamin E or up to 600 IU as tocotrienols; 10-50 mg of zinc; up to 200 mcg of selenium
B6 protects the heart against further damage, and thiamine (B1) can improve its pumping capacity, while niacin, or nicotinic acid (B3), can increase HDL (good) cholesterol.
Suggested daily dosages: 100 mg of vitamin B6; 50 mg of thiamine. Get your body used to niacin by starting with a 25-mg dose with food (just chop a 100-mg tablet into four pieces) and, after a few days, increasing the dose to 50 mg, then increasing it again after a few more days. The optimal therapeutic dose is 400 mg
Found in fish oil, these essential fatty acids markedly reduce bad LDL cholesterol and triglycerides while increasing good HDL. Take alongside the antioxidant vitamin E to prevent possible cell damage.
Suggested daily dosage: 1,000-1,500 mg as fish oil
Made in the body from amino acids (lysine and methionine), high doses of this compound delivered intravenously can reduce ventricular arrhythmias after a heart attack.
Suggested daily dosage: 250-750 mg
Prevents heartbeat irregularities and cell/tissue damage after a heart attack. Choose a formula that contains ubiquinol, which is more readily taken up by the body.
Suggested daily dosage: 60-100 mg/day (or higher with supervision)
Chromium and magnesium.
According to a large-scale study by British laboratory-testing service Biolab Medical Unit in London, people become deficient in both chromium and magnesium with age, and both are necessary for heart health. Magnesium lowers high blood pressure too.
Suggested daily dosage: 100 mcg of chromium; 200-600 mg of magnesium
Offers natural protection against most types of heart disease, while boosting vascular function.
Suggested daily dosage: 600-1,000 IU vitamin D; 400-1,000 IU if aged 18 or under
High-quality probiotics that include lactobacilli, bifidobacteria, Saccharomyces boulardii, non-disease-causing strains of Escherichia coli and streptococci can lower blood pressure after just a couple of months.
The best alternatives
Derived from pineapple, can ease angina and various cardiovascular disorders, as can hawthorn (Crataegus species) extracts.
Ginger (Zingiber officinale)
A recognized blood-thinner, can halt the development of blocked or narrowed arteries.
Can reduce pain in heart patients, help them walk longer distances and also 'thin' the blood of patients with arteriosclerotic disorders.
An Indian medicinal plant, can reduce the signs and symptoms of heart failure.
Can have profound effects on the heart. Andrographis paniculata Nees (also known in Indian Ayurvedic medicine as Bhui-neem), for example, can help prevent recurrent narrowing of arteries after angioplasty.
Derived from the resin of the guggul tree (Commiphora mukul), is an Ayurvedic remedy that can prevent atherosclerosis and raise 'good' HDL in 60 per cent of cases, while significantly lowering 'bad' LDL cholesterol.
Lowering your blood pressure naturally
One good way to begin repairing your heart is by reducing your blood pressure, which can be a warning sign of stroke, heart attack and heart failure, aneurysms (blood clots in the brain), peripheral artery disease and even chronic kidney problems.
But even if your blood pressure is over the so-called normal 140/90 mmHg and you're terrified that your high blood pressure will lead to a heart attack or stroke, simple lifestyle changes can bring your blood pressure back to normal. You can try these suggestions one at a time or several of them together, although it's best to work with a healthcare practitioner experienced in non-drug methods of blood pressure control.
There's no question that weight affects your blood pressure, and that losing pounds lowers it.
Avoid processed carbs
A low glycaemic index (GI) diet can regularize your metabolism, help you lose weight, reduce blood sugar and insulin levels, and lower blood pressure.
Take organic apple cider or wine vinegar daily
This works like an ACE inhibitor by suppressing the renin-angiotensin hormones that regulate blood pressure balance. When too much angiotensin is secreted thanks to an overactive hormone system, blood vessels constrict.
Suggested daily dosage: 1 Tbsp or 15 mL in half a glass of water
Watermelon (cucurbita citrullus) extract
This can dilate capillaries, the tiny blood vessels that run between arteries and veins. In one study, L-citrulline supplements significantly reduced the risk of a serious cardiac event in obese adults with high blood pressure.
Suggested daily dosage: 2-3 g of l-citrulline (available online)
A review of 11 studies found that garlic preparations can significantly reduce high blood pressure.
Suggested daily dosage: 600-900 mg of garlic powder
Achillea wilhelmsii extract
This Iranian plant (a member of the Asteraceae family) significantly lowered blood pressure after six months.
Suggested daily dosage: 15-20 drops twice daily as a water-and-alcohol extract
Patients given 250 mg/day of Lyc-O-Mato gel capsules, containing 15 mg of lycopene plus other carotenoids, enjoyed significant reductions in blood pressure after just two months.
These naturally occurring peptides (chains of amino acids) are derived from plants and animals, and act like ACE inhibitor drugs to lower blood pressure. Again, these are available online.
Homeopathic Cytisus Laburnum
Prepared from the flowers and young leaves of wild laburnum, this remedy has worked for many patients. It has also been put through a modern homeopathic proving to test its effects.
Suggested daily dosage: 6DH potency twice daily
Aged garlic extract
Besides garlic preparations, this can lower blood pressure in people with hypertension that remains uncontrolled
This all-purpose heart supplement reduces blood pressure by relaxing blood vessel walls.
Learn to unwind and control your own blood pressure with the StressEraser, a portable biofeedback device that teaches you how to activate your own 'relaxation response' by revealing your heart rate on a screen, which you then synchronize to your breathing.
The device is available online in the UK at www.stresseraser-uk.com, and in the US at www.stresseraser.com.
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Published in the February 2015 Issue