Cardiologists say heart patients are prescribed too many medications
Some cardiologists think patients with heart disease are on too many medications, and that the doctors prescribing them may be compromising treatment.
Several of the nation’s leading cardiologists voiced such concerns at the American College of Cardiology sessions in San Francisco this past week, saying that reducing certain medications may actually improve care. They also pointed to growing research that indicates some of the drugs typically prescribed for patients with heart disease may not even work.
Of the nation’s 80-million patients suffering from heart disease, most are on multiple medications, but according to cardiologist Dr. Steven Nissen of the Cleveland Clinic, having to take several doses of different drugs can cause patients to forget to take them.
"There is also the question about whether the benefits are additive," Nissen added.
Some of the medications cardiologists often prescribe, but are reconsidering, include prescription niacin to raise good cholesterol, as well as beta-blockers and triglyceride reducing drugs like TriCor. When combined with additional drugs, such as blood pressure medication, blood thinners and cholesterol reducing statins, patients with heart disease can typically be on multiple medications with multiple dosing schedules at once – some of which may not even be necessary, or even dangerous by some doctor’s standards.
"That's a minimum of five medications, and each one has a proven mortality benefit. It's practically malpractice if you don't prescribe those," said cardiologist Dr. Micah Eimer of Northwestern Medicine in Chicago.
According to research conducted by Dr. Harlan Krumholz, professor of cardiology and public health at Yale University, heart failure patients were prescribed 12 drugs on average, with some on many as 30 – even though their hearts were too weak to pump blood sufficiently.
"We are eager to add medicines and reluctant to take them away," said Krumholz, who heads the Yale-New Haven Hospital Center for Outcomes Research and Evaluation and is a frequent critic of how drugs are sold and used. "So people accrue medications over time."
Krumholz also pointed out that while many drugs are prescribed widely, evidence they actually work is weak.
Serious side effects are another problem with prescribing multiple medications. At a conference last Saturday, results were released from a study of more than 25,000 people taking a niacin drug who experienced unexpected major side effects. Made by Merk & Co, the drug caused significantly more bleeding and a higher number of infections than researchers had expected.
This isn’t the first time Merk has encountered failure with one of its heart medications. When it was announced that its drug, Tredaptive, failed to prevent heart attacks, strokes and death in heart patients also taking drugs to lower bad LDL cholesterol, Merck said it would not seek U.S. approval and would stop selling it in the dozens of other countries where it was already available.
Other drug companies have experienced similar failures with their own lines of cardiovascular medications, including AbbVie's TriCor.
Yet, in spite of these failures, there are some medications that cardiologists says heart patients really do need to be on. These include drugs to control various risk factors, such as cholesterol, high blood pressure and diabetes.
"Doctors should look for combination pills if they can, and exclude pills that don't critically help patient care," said American Heart Association spokesman, Dr. Richard Stein, a professor of medicine at New York University. "To live your life taking that many pills, the danger is you'll stop taking the critical ones, because how many pills can you take several times a day?"
American College of Cardiology, CardioSource News