Answers to Common Questions
Find answers to frequently asked questions about medications, like how they work and possible side effects.
Your statement is correct. Vitamin K is an essential cofactor for the synthesis of clotting factors. The effect of anticoagulants (blood thinners) like Coumadin is inhibited by intake or supplementation of vitamin K. Plavix, on the other hand, is a compound that inhibits platelet function. Plavix has no known interactions with vitamin K.
Simone Musco, MD, FACC
I recently had some chest pain, so I went to a doctor who happened to be a cardiologist. Because I am overweight and my blood pressure that day was high, the doctor sent me for a nuclear stress test which came out normal. My concern is she prescribed a beta-blocker, nebivolol (Bystolic) 5mg. Do I need to take this medicine? If not, what harm is it doing to my heart?
The answer is that it depends. The newest hypertension guidelines recommend treating your blood pressure if it is, on average, higher than 140/90 mmHg. However, there are cheaper medications with fewer side effects than Bystolic, like ACE inhibitors and hydrochlorothiazide, which could be used to treat your blood pressure. There are some "natural" ways to combat high blood pressure: limit your salt (sodium) intake to no more than 2 grams daily, try to get 150 minutes a week of moderate intensity exercise and 60 minutes of strength training in a week, and work on weight loss. The DASH Diet is a recommended diet to help with weight loss, controlling sodium intake and improving blood pressure. Bystolic is unlikely to be "harming" your heart. It just lowers your heart rate and your blood pressure. You are taking a low dose of it so stopping it abruptly should not be a problem. It, like other beta-blockers, can make you feel sluggish, depressed, tired, and dizzy with position changes. It is worth discussing your options with your primary care doctor as well as working on therapeutic lifestyle changes to keep your heart healthy.
Susan Matulevicius, MD, MSCS, FACC
UT Southwestern Clinical Heart Center
What drug, if any, is used to lower LDL when a person has severe reactions to statins?
For those who are truly intolerant to statins, options for effective and proven therapy are limited. Firstly, I would encourage you to work with your cardiologist to try some of the newer statins such as pitivastatin or similar and see if these don’t bother you as much. If they do, other options are bile acid sequestrants such as colesevelam, which are sometimes effective. Another option is ezetimibe, a cholesterol absorption inhibitor. The data on this drug is even less strong—it may in fact lower LDL, but may not do much to necessarily improve outcomes.
Perhaps the best non-statin way to lower your cholesterol is lifestyle. In addition to a minimum of 30 minutes of brisk cardiovascular exercise each day (working hard enough so that you cannot complete a sentence while exercising), eating a more plant-based, or in some cases, a solely plant-based (vegan) diet is the most powerful way to lower your cholesterol and of course your LDL. There is much data showing that a plant-based diet can help to reduce the likelihood of having a coronary event and may even help to halt the progression of atherosclerosis. A great place to get started with exercise is Walk with a Doc, and a great resource for plant-based diets is PCRM’s 21-Day Vegan Kickstart.
Andrew M. Freeman, MD, FACC, FACP
Atrial fibrillation is the most common clinical arrhythmia. Approximately 5% of the population ages 60 years and older has it! The most significant risk of atrial fibrillation is stroke, and the first step is deciding what type of anticoagulation (anti-clotting medication) is appropriate for your situation. Aspirin alone may be adequate, but you may require warfarin or one of the novel oral anticoagulants that can be used in place of warfarin. The next issue is to determine how to manage the heart rhythm abnormality itself.
A rhythm control strategy is when you are given medication (antiarrhythmics like flecainide, propafenone, amiodarone, sotatol, dofetilide, and dronedarone) to prevent atrial fibrillation from happening. This is ideal for patients with severe symptoms. These medications help maintain a normal rhythm.
A rate control strategy allows the presence of atrial fibrillation but prevents fast heart rates with medications to slow your heart rate. This is a good option for patients who do not feel their atrial fibrillation. Medications to help slow your heart while you are in atrial fibrillation include beta blockers (e.g., metoprolol, atenolol, and carvedilol), calcium channel blockers (e.g., diltiazem and verapamil), and digoxin.
Most importantly, be patient with your care provider! Atrial fibrillation will not be fixed (or understood) in a single visit. A medicine that works for one patient may not work for another.
Jeffrey L. Williams, MD, MS, FACC, FHRS
Digoxin (Lanoxin) is a medication that helps strengthen heart muscle contractions, control heart rate and reduce heart failure symptoms. Digoxin is most commonly used to treat heart failure and abnormal heart rhythms (arrhythmias).