Tag Archive for: ejection fraction

Are Heart Meds Forever?

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The prevailing thought on pharmacological treatment of cardiovascular disease (CVD) is that once you’re on a class of medications, you’re on them for life—new meds may be developed to replace some, but treatment continues forever. That contributes to the conspiracies about big pharma and the greed of the medical community. I’m not going to say that never happens, but maybe a recent study can reveal a ray of hope.

Beta-Blocker Study

Researchers selected a very specific group of potential subjects from three countries. The subjects must have had a myocardial infarction (MI), also known as a heart attack; they must have had both angiography and an echocardiogram; they must have an ejection fraction equal to 50% or more; and they were tracked for 3.5 years.

This is the important part: On a randomized basis, half were given the typical treatment of beta-blockers while the other half were not. There were two intermediate analyses of the data to make sure the non-beta blocker group were not at greater risk for problems such as another MI, or worse yet, death.

The analyses demonstrated that there were no differences in outcomes related to any CVD condition between the groups. In other words, the beta-blocker did not provide any additional benefit. There are more trials underway to confirm these results, but we now have a first step on the path to determining whether medications are necessary for life or not.

The Bottom Line

Let me be clear: Do not stop any medication without discussing it with your physician! All physicians were aware that their patients were in the trial and who was and was not on beta-blockers. Also, the standard for ejection fractions (amount of blood pumped per beat) was relatively high. But it illustrates this point: Every visit to your physician or specialist should include a thorough discussion of your medications and whether you need to remain on each one.

There’s also another part to all this: What are you willing to do to help eliminate the need for the medication? Diet, exercise, reducing body weight? What will you do if it will help? In other words:

What are you prepared to do today?

        Dr. Chet

Reference:  N Engl J Med 2024;390:1372-81

Aging Stressor: The Cardiovascular System

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The next three Memos before Christmas will identify the three major stressors of aging as I see them and the general solution to them. The first stressor of aging is the changes to the cardiovascular system (CV). Cells wear out in all systems at all ages, but there are some that stop replacing and repairing themselves in the CV. A few examples:

  • The sino-atrial node is the pacemaker of the heart. As we get older, some of the specialized nerve cells of this area are not replaced. That can cause abnormal heart rhythms such as atrial fibrillation.
  • The arteries can become less pliable, called arteriosclerosis, which can cause an increase in blood pressure. (Atherosclerosis, the buildup of plaque in arteries, can be considered a special type of arteriosclerosis and can happen at any age depending on genetics and lifestyle.)
  • The heart muscle can get damaged and be replaced with scar tissue. That automatically weakens the heart, which pumps less blood (called the ejection fraction) and reduces fitness levels.

The solution? CV exercise, also called aerobic exercise: walking, riding an exercise bike, swimming or water aerobics, or pulling a sleigh (just checking to make sure you’re reading.) It doesn’t matter which mode you choose as long as you move your body for 30 to 45 minutes per day most days of the week. You can’t reverse every effect of aging on the CV and other systems, but nothing impacts every system of the body like exercise does. Aging with a vengeance requires aerobic exercise within the limitations you currently have, and the younger you start, the more successful you’ll be.

What are you prepared to do today?

        Dr. Chet