Medications Archive

This heart rhythm disorder is linked to thinking and memory problems. But anti-clotting drugs may lower the risk.

Bouts of atrial fibrillation, or afib — a rapid, chaotic heartbeat — make some people feel lightheaded and dizzy, while others don't notice any symptoms. But the most serious threat of this condition is the higher risk of stroke among people with afib compared with those without the disorder (see "Blood clot dangers, large and small"). Now, there's a growing recognition that people with afib also face an increased risk of thinking and memory problems — even if they do not experience a stroke.

Known as cognitive impairment, these problems include trouble remembering, learning new things, concentrating, or making routine decisions. The presumed underlying cause? Tiny blood clots that cause "silent" (that is, unrecognized) strokes and gradually injure parts of the brain involved with cognition.

Research we're watching

About four in 1,000 adults in this country are born with a genetic condition marked by abnormally high cholesterol levels, known as familial hypercholesterolemia (FH). Their "bad" LDL cholesterol can be two to three times as high as the common target LDL value of 100 milligrams per deciliter (mg/dL) or lower for healthy people. But only about half of people with FH are getting proper treatment for the disease, according to a report in the May 22 issue of Circulation.

For the study, researchers analyzed health surveys done between 1999 and 2014 with nearly 42,500 adults in the United States. Although more than 80% of people with FH or severely high cholesterol were aware of their condition, only half were taking cholesterol-lowering statins. And among those who were, only one-third were taking optimal doses of the drugs.

Be proactive by learning about and tracking your conditions and medications, and by speaking up when you have concerns.

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We don't want our golden years to be spent juggling a long list of health issues. But that's the reality for most older adults in the United States.

The CDC reports that 75% of Americans ages 65 or older have several chronic health problems. And a 2013 analysis of Medicare claims published online by Preventing Chronic Disease found that 68% of beneficiaries had two or more chronic conditions and 36% had at least four.

Ask the doctor

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Q. Home remedies aren't stopping my hiccups. Is there something my doctor can prescribe to help?

A. In the May 2018 issue, I answered a question about hiccups, saying they are common but typically short-lived, and that simple home remedies often can end them. However, I ran out of space to say something about treatments for the very unusual cases of hiccups that don't respond to simple treatments.

Ask the doctor

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Q. I understand there's a genetic test that can tell you how well you might respond to antiplatelet drugs. Do you recommend this test?

A. The short answer is no, not yet. For now, I think it is best to wait for the results from studies looking at personalized antiplatelet therapy. Also known as tailored medical therapy, personalized therapy refers to treatments that are based on your own information, including genetics. But first, I will address two other relevant questions: (1) what is antiplatelet therapy, and (2) who needs it?

For people at high risk, PCSK9 inhibitors may prevent heart attacks and save lives. But gaining access to these pricey drugs remains a challenge.

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Three years ago, the FDA approved two drugs that lower harmful LDL cholesterol values dramatically — by more than 50%. The drugs, alirocumab (Praluent) and evolocumab (Repatha), belong to a new category of medications known as PCSK9 inhibitors. Both are given by a self-administered injection once or twice a month.

They're intended for people whose cholesterol levels remain stubbornly high, despite making lifestyle changes (such as diet and exercise) and taking the maximum dose of a high-potency statin and other cholesterol-lowering drugs. In the past two years, results from two large studies found that both PCSK9 inhibitors lowered the risk of serious heart-related events such as heart attack and stroke by 15%.

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Newer medications, which may be safer than earlier drugs, have expanded the options for treating obesity.

Obesity is now considered more than a risk factor for other conditions; it's a disease itself. It has been the subject of intense scientific and medical research to develop effective treatments. But the quest has been elusive.

The Surgeon General has issued an advisory recommending that people carry and know how to use naloxone, and although it is an effective treatment for overdose, it does not address the larger issues around the opioid crisis.

Do these heavily promoted hormones justify the claims made for them?

"Bioidentical" hormones have been promoted as safer and more effective than FDA-approved hormones. The exaggerated claims go beyond relief of menopausal symptoms, suggesting they are a veritable fountain of youth.

It's understandable that women would be interested in a different approach now that long-term use of conventional hormone therapy (HT) does not prevent cardiovascular disease as researchers had hoped.

You may need to stop taking blood thinners, certain painkillers, herbs, and supplements to reduce your risk for bleeding.

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No one wants to have surgery, even minor surgery, but sometimes minor procedures, such as a tooth extraction or a colonoscopy, are unavoidable. When that happens, you may hear that it's important to stop taking certain medications. Understanding exactly which drugs to suspend — and when — can be confusing. "I get a lot of questions about this," says Joanne Doyle Petrongolo, a pharmacist at Harvard-affiliated Massachusetts General Hospital.

Blood thinners

All surgery involves cutting body tissue, and that leads to bleeding. Blood thinners—medications like anticoagulants and antiplatelet drugs—can boost the risk for bleeding by keeping the blood from clotting.