“I have the most difficulty dealing with educated patients who Google their prescriptions and come back with half-baked information from the internet and social media forwards,” complains Dr R Rajendran, Chief Consultant Interventional Cardiologist at Kauvery Hospital, Salem. Incomplete internet research isn’t advisable in most medical situations, but it can be downright disastrous for patients recovering from a heart attack or a cardiac procedure like an angioplasty.
One of the most common but serious effects of such misinformation among cardiac patients is a hesitancy towards long-term medication following a heart attack, explains Dr Rajendran. “Patients think that after getting an angioplasty or a stent following a heart attack, they can stop their medication after six months to one year. They become sceptical about continuing drugs for longer periods,” he says. This can cause serious problems as certain classes of drugs prescribed after a heart attack must be taken for long periods, including for the rest of a patient’s life.
Heart attacks are caused by coronary artery disease. Following a heart attack or a surgical intervention such as angioplasty or a stent implantation, a major priority for doctors is secondary prevention or reducing the possibility of further attacks or associated conditions such as a stroke. This requires controlling blood pressure to prevent arterial narrowing, reducing cholesterol to prevent the formation of atherosclerotic plaque or hardened cholesterol build-up in the arteries, and regulating blood coagulation to prevent the formation of clots in major blood vessels.
Dr R Rajendran, Chief Consultant Interventional Cardiologist at Kauvery Hospital, Salem.
Many of these drugs have been studied and tested over long periods of time and are considered safe and reliable as long as they are taken according to the recommended dosages and with due precautions. “It is important for doctors to explain to patients that these drugs are necessary for improving their quality of life,” says Dr Rajendran.
Search for many of the medications prescribed after a heart attack and you’re bound to run into websites raising concerns about side effects. While it is necessary to be careful about taking these medications according to your doctor’s advice, excessive focus on side effects often becomes alarmist and scares patients, says Dr Rajendran.
What many patients don’t take into account is that the side effects of these drugs are well-known, often reversible and manageable, and are not too common, says Dr Rajendran. “Side effects only occur in a minority of patients. And, we can always prescribe different medications or tweak the dosage in order to minimise these effects,” he explains.
These misperceptions are most evident in the case of statins, which are cholesterol reducing drugs that have been prescribed to heart patients since the 1990s. Despite this long history, and the multiple studies proving the benefits of these drugs, a misguided debate into side effects of statins continues, not only in India but elsewhere in the world as well. “There are half-baked theories that pharmaceutical companies are sponsoring doctors to continue prescribing these medications,” says Dr Rajendran.
When looking at the role of statins, it’s not only the blood cholesterol level that matters, he explains. “Patients often come to me and ask why they should continue taking statins if their cholesterol has reduced. But beyond reduction in blood cholesterol, statins also reduce atherosclerotic plaque burden or plaque size, improving blood flow within the heart and preventing heart attacks.”
Many patients balk at the thought of lifelong medication because they associate drugs with sickness, says Dr Rajendran. “They don’t like to think of themselves as being sick and this makes them resistant to taking medication continuously,” explains Dr Rajendran.
Kauvery Hospital, Salem.
It is therefore important to reframe one’s view in terms of prevention. While diet, exercise and other holistic therapies and lifestyle changes can contribute to improving heart health, none of them are as effective in preventing a heart attack. Hence, it’s important to see lifelong medications as similar to these other methods, but vastly more effective, Dr Rajendran says.
“Secondary prevention is vital for heart patients to ensure that they don’t suffer further heart attacks. Anti-platelet, anti-cholesterol and blood pressure modifying medications are all vital for them to lead a long and vital life,” he says.
This article was created in association with Kauvery Hospital.