~Cardiovascular Disease Comprehensive 17 - Prescription Drug Risks

  • Nitroglycerin Drugs and Angina
  • Class I Anti-Arrhythmic Drugs
  • The Proper Anti-Hypertensive Medication
Many people are unaware that there may be risks associated with taking commonly prescribed prescription medications. In addition, once-daily dosing of certain drugs such as anti-hypertensive agents may not provide 24-hour protection against arterial damage. Individuals who are currently taking any of the medications described in this section are urged to discuss alternative treatment options with their physician.

Nitroglycerin Drugs and Angina

Angina is a sudden intense pain in the chest that is often accompanied by a feeling of suffocation. Angina is caused by a momentary lack of adequate blood supply to the heart muscle. Individuals who have occluded coronary arteries often experience periodic bouts of angina.

Nitroglycerin temporarily dilates blood vessels and reduces workload on the heart. As early as 1879, nitroglycerin was administered to an angina patient (Kipple 1993). Nitroglycerin worked so well that nitroglycerin and other "nitrate" drugs have been used as standard angina therapy ever since. Unfortunately, while these nitrate drugs do provide temporary relief from angina, regular use of nitrate drugs may increase the risk of a future heart attack.

A startling new finding came from a Japanese study that involved 518 patients with suspected coronary artery disease (Murakami et al. 2002). The patients were categorized into groups based on their degree of endothelial dysfunction (a measurement of inner arterial wall damage) and the use of nitrate drugs.

These 518 patients were followed for 45 months to ascertain which patients were more likely to experience major cardiovascular events. As expected, patients with severe endothelial dysfunction had significantly more heart attacks, strokes, bypass surgeries, congestive heart failure, etc. However, the surprising finding was that those who regularly used nitrate drugs were 2.42 times more likely to experience major cardiovascular events. The researchers concluded that the effects of nitrate drugs accelerated atherogenic processes and endothelial dysfunction and that use of nitrate drugs caused future cardiovascular events (Murakami et al. 2002).

Millions of Americans with coronary artery disease have been prescribed nitrate drugs. However, there is now evidence that nitrate drugs actually accelerate arterial wall damage (endothelial dysfunction) and thus contribute to progression of coronary artery disease--the very disorder that the nitrate drugs have been prescribed to alleviate.

Angina patients who rely on nitrate drugs should bring this new information to the attention of their physician. It is important to note that occasional use of a nitrate drug to relieve angina symptoms was not shown to be dangerous in the most recent study. It was the regular use of a nitrate or nitroglycerin drug that increased the risk of heart attack by 2.42 times within a 45-month period (Murakami et al. 2002).

Commonly Prescribed Nitrate Drugs

A 2002 study indicating danger from nitrate drugs referred to regular use rather than occasional use (Murakami et al. 2002). It is highly unlikely that occasional use of a nitrate drug to relieve angina symptoms would cause a problem. However, regular use of a nitrate or nitroglycerin drug more than doubled the risk of heart attack or other pathological vascular event. Commonly prescribed nitrate and nitroglycerin drugs are:
  • Isosorbide Nitro-Dur Transdermal Infusion
  • Isosorbide Dinitrate Nitrolingual Pump Spray
  • Isosorbide Mononitrate Nitrostat tablets
  • Nitroglycerin patches Minitran Transdermal Delivery System
For information about an FDA-approved technique that has been shown to safely reduce angina symptoms, refer to "A Non-Invasive Alternative to Coronary Bypass Surgery."

Dietary supplements that have been shown to help protect against endothelial dysfunction include:
  • Folic acid (Title et al. 2000a; Woo et al. 2002)
  • Vitamin C (Richartz et al. 2001; Pullin et al. 2002)
  • Vitamin E (Title et al. 2000b; Raghuveer et al. 2001)
  • Arginine (Maxwell et al. 2000; Kawano et al. 2002; Lekakis et al. 2002)
  • Taurine (Wang et al. 1996; Fennessy et al. 2003)
  • Fish oil (Chin et al. 1994; Morita et al. 2001; Goodfellow et al. 2000)
It should be pointed out that if left untreated, endothelial dysfunction may become so severe that it will not be possible to reverse it with currently available therapies.

The term endothelial dysfunction is increasingly being described in scientific journals as a significant underlying cause of most forms of cardiovascular disease, including hypertension, atherosclerosis, and congestive heart failure.

Class I Anti-Arrhythmic Drugs Kill Thousands

In the June 1995 issue of Life Extension magazine, an article exposed the dangers of a class of anti-arrhythmic drugs the FDA had approved to prevent lethal heart arrhythmias (LEF 1995). In this 1995 article, evidence was introduced that the FDA knew of the risks these drugs posed, but had approved them anyway. When the FDA was confronted with accusations that these drugs had been improperly approved, the reply was that the FDA had a theory that these drugs would save the lives of more people by preventing abnormal heartbeats than the drugs would kill by causing abnormal heartbeats. The problem was that the FDA had no evidence that these drugs would save even a single life.

Even after a large study conducted by the National Heart, Lung and Blood Institute showed that anti-arrhythmic drugs had killed large numbers of Americans, the FDA's response was not to remove the drugs, but to merely suggest changes in the labeling of the drugs (CAST 1989; NHLBI. 2002).

True to its word, the FDA did mandate a change in the labeling of at least one of these anti-arrhythmic drugs (Tambocor®). On page 1889 of the year 2003 Physician's Desk Reference, a large warning box appears containing the following statement:

"An excessive mortality or non-fatal cardiac arrest was seen in patients treated with Tambocor compared with that seen in patients assigned to a carefully matched placebo-treated group. This rate was 16/315 (5.1%) for Tambocor and 7/309 (2.3%) for the matched placebo."

What this warning means is that if you take Tambocor (flecainide), your risk of dying or experiencing a heart attack is more than double compared to taking a placebo.

The sordid history of the FDA's approval of Tambocor and other lethal Class I anti-arrhythmic drugs is chronicled in the book Deadly Medicine by Thomas J. Moore (1995).

Are You Taking the Proper Anti-Hypertensive Medication?

The Life Extension Foundation has repeatedly warned persons with high blood pressure (hypertension) to not depend on one-a-day dosing of anti-hypertensive drugs because many of these drugs do not provide complete 24-hour protection. When an anti-hypertensive drug wears off, the patient is vulnerable to having a stroke. One solution to this problem is to take a lower dose of the anti-hypertensive drug twice a day, even though the FDA claims that one-a-day dosing is adequate.

Failure to keep blood pressure at optimal low levels (below 120/85) dramatically increases mortality risk. The United States government states that blood pressure readings as high as 140/90 are acceptable (CDC 2002), but published results of human studies clearly show that maintaining levels below 120/85 confer longevity and protection against heart attack and stroke (Stamler et al. 1993; Stamler 1999).

The best-selling anti-hypertensive drugs in the United States are not necessarily the most effective. Advertising by drug companies and physician "force-of-habit" prescribing often result in hypertensive individuals taking drugs that do not provide optimal blood pressure-lowering effects.

Life Extension long ago recommended a class of anti-hypertension drugs known as angiotension II receptor blockers. Some of the first drugs approved in this class where Cozaar® and Hyzaar® and Life Extension has suggested them as first line therapy. The only drawback to these drugs was that they did not provide consistent one-a-day protection.

A new drug in this class is called Benicar®. A recent study indicated that Benicar may be the first drug to provide true 24-hour blood pressure reduction (Neutel et al. 2002). A typical starting dose of Benicar is 20 mg a day. For patients requiring further reduction in blood pressure, the dose can be increased to 40 mg a day after 2 weeks.

Optimal control of hypertension requires blood pressure checks throughout the day. This is the only way to be certain an anti-hypertensive drug is not wearing off, endangering the arterial system. Even if you take Benicar, it is still critical to verify that it is actually keeping your blood pressure suppressed during an entire 24-hour period.

Continued . . .

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