Why Does One Condition Require So Many Medications?

When people are first diagnosed with heart disease, they often leave their doctor's office with a fist full of prescriptions, a bag full of medication samples, and a mind full of questions. "Why so many medications, doc? What do they do?"

The short answer is that coronary heart disease has many different components. The more medical researchers find out about this complex disease, the more specific and targeted the medications can become. Controlling this disease requires taking measures to prevent the formation of blood clots, to reduce inflammation of the blood vessels, and to inhibit cholesterol formation and transport within the body.

These efforts are designed only to prevent further advancement of atherosclerosis. Once atherosclerosis has progressed to the point where it produces symptoms, therapies are needed to enable the heart to work more efficiently and accommodate to the reduction in coronary blood flow.

Let's look at the medical management (as opposed to surgical management) of coronary heart disease.

Preventing Clots with Platelet Inhibitors

Anticoagulants are an important part of treating coronary heart disease because they interrupt the interaction of several elements circulating in the blood from forming clots. A blood clot prevents the flow of blood to your heart, which results in a heart attack and damage to the heart muscle, and prevents the flow of blood to your brain, which results in a stroke and damages the brain. The most common two drug therapies are aspirin and clopidogrel (Plavix).

Lowering Cholesterol

There is a wealth of scientific data showing the link between high LDL cholesterol and plaque formation inside our coronary arteries. Contrary to popular belief, cholesterol does not simply build up inside the arteries to form a blockage. Researchers now know that the role of "bad" cholesterol in heart disease is actually far more complex, helping to trigger an inflammatory process that happens within the blood vessel wall, causing it to weaken, enlarge, and eventually block blood flow. There are lots of medications to lower cholesterol, the most common of which are statins, fibrates, and nicotinic acid, or niacin.

ACE Inhibitors and ARB Drugs

Drugs referred to as ACE inhibitors (ACE stands for angiotensin-converting enzyme) have emerged as some of the most beneficial treatments for people with heart disease. A group of drugs called ARB agents (ARB stands for angiotensin-receptor-blocking) have also been shown quite effective. Both of these drug classes work with the hormone angiotensin II, which plays a key role in elevating blood pressure. Clinical trials have shown ACE inhibitors and ARB agents to be highly effective in preventing coronary heart disease in high-risk groups by treating hypertension, a leading risk factor for heart attacks.

Drugs for Treating Uncomfortable Pain Symptoms

Angina pectoris, or angina for short, is a term that describes chest pain caused when the amount of oxygen getting to the heart muscle is insufficient. It usually occurs on exertion, is relieved by rest, and is both a symptom and warning sign for coronary heart disease. Researchers have developed a medicine chest of drugs that treat angina. Here is a sampling.

Nitroglycerin compounds - The little pill movie characters put under their tongue while clutching at their chest in pain is nitroglycerin. Nitroglycerin-containing compounds treat chest pain (angina) by dramatically lowering blood pressure.

Alpha- and Beta-Blocking Drugs - These drugs block the action of the alpha, beta, or both receptors, which are located in the surface cells of the cardiovascular system and cause the arteries to constrict (alpha receptors) or dilate (beta receptors), thus increasing the heart's work and oxygen consumption, leading to chest pain.

Calcium-Channel-Blocking Agents - Simply put, the more calcium inside each cell, the more vigorous the contraction of the heart and the more angina, or heart pain. Calcium-channel-blocking agents block the delivery of calcium into cardiac cells, thus minimizing contractions and chest pain.

How many of these drugs you need to take is, of course, determined by your particular condition and the course of action you and your physician agree upon. In many cases, medication can be an effective alternative to heart surgery, and advances in drug therapies have greatly reduced the discomfort of heart disease.