Key takeaways:
Heart attacks are usually caused by blood clots that form where cholesterol plaques have built up in the heart’s arteries. “Blood-thinning” medications, like aspirin, are usually prescribed to help prevent future heart attacks.
Other medications, including statins and beta blockers, may help protect your heart and reduce your risk of long-term heart conditions.
If you have side effects from any of your heart medications, there are often other options that have similar benefits.
Save on related medications
Every year, over 800,000 people in the U.S. have a heart attack (myocardial infarction). After a heart attack, at least 1 in 5 people will have another one within the next 5 years. Heart disease is the leading cause of death in the United States. But with prompt medical care, most people will survive a heart attack.
If you’ve had a heart attack, there are usually some important changes you can make to help prevent another one. One of the most important is to take the medications recommended by your cardiologist. In this article, we’ll go over the common heart attack medications that you may be prescribed. We’ll discuss the benefits of each one and explain possible side effects to look out for.
Overview of heart attack medications
Most heart attacks happen because of cholesterol buildup, or plaque, in the heart’s arteries. Another name for this is atherosclerosis. A heart attack happens when a cholesterol plaque cracks open. Your body treats this like an injury and sends platelets and other clotting substances to the area. The clot may partly or completely block the artery, leading to a heart attack.
Heart attack medications work on several different levels:
Treating the urgent problem (the heart attack)
Helping your heart to recover from the damage
Preventing future heart attacks
Some medications can do all three things. Other medications may only be used for a short period of time.
Emergency heart attack medications
If you think you might be having a heart attack, call 911 so that you can get emergency care right away. The sooner you get help, the more likely your heart is to recover.
Heart attack medications that are most often used in the first few hours of a heart attack include:
Aspirin: an anti-platelet drug that helps to make your platelets less “sticky”
Nitroglycerin: temporarily widens blood vessels so blood can flow more easily
Beta blockers: lowers heart rate and blood pressure and reduces the workload of your heart
Heparin: an intravenous (IV) blood thinner that can help prevent further clotting
Thrombolytics: “clot-busters” that are sometimes used when a blocked artery can’t be opened right away with a stent
If you’re being treated for a heart attack, it’s very important to let your care team know if you’re taking any form of blood thinners, such as Eliquis, Pradaxa, or Xarelto. You should also tell them if you’ve recently taken Viagra or another erectile dysfunction medication. These medications can interact with nitroglycerin and cause dangerously low blood pressure.
Long-term heart attack recovery medications
After a heart attack, you’ll probably need several different medications. The options can vary depending on the size of your heart attack, how it was treated, and what risk factors you have.
These might include:
Antiplatelet medications
Statins or other cholesterol-lowering medications
Beta blockers
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs)
If you have other health conditions, like high blood pressure, diabetes or obesity, you may need additional medications to help lower your risk of future heart problems.
A healthy lifestyle can also protect your heart. This includes exercise, eating a nutritious diet, and avoiding tobacco.
Antiplatelet medications
Platelets are specialized blood cells that help to form clots. Antiplatelet medications help stop platelets from clumping together. The two kinds of antiplatelet medications used after heart attacks are aspirin and P2Y12 inhibitors.
Aspirin
Aspirin is available over the counter (OTC). If you have a heart attack, you’ll likely need to take aspirin (or another antiplatelet medication) for the rest of your life to help prevent another heart attack. Most of the time, the dose will be 81 mg, sometimes called “baby aspirin.”
Common side effects of aspirin include upset stomach and heartburn. Because aspirin helps prevent your blood from clotting, it and other antiplatelet medications may raise your risk of bleeding.
If you can’t take aspirin because of an allergy or another reason, you may be prescribed a daily P2Y12 inhibitor instead. For up to a year after a heart attack, your cardiologist may prescribe aspirin plus a P2Y12 inhibitor. We’ll cover this combined therapy in more detail in the next section.
P2Y12 inhibitors
Like aspirin, P2Y12 inhibitors work by preventing platelets from sticking together. These medications include:
Clopidogrel (Plavix)
Prasugrel (Effient)
Ticagrelor (Brilinta)
If your heart attack was treated with a stent, you’ll usually need to take both a P2Y12 inhibitor and aspirin. Most people will take both for 12 months after a heart attack. The length of treatment can vary depending on what kind of stent you have and your other health conditions.
P2Y12 inhibitors may raise your bleeding risk. But there are some important differences among these medications:
Prasugrel and ticagrelor are usually more effective than clopidogrel.
Prasugrel should usually be avoided if you’ve had a stroke or transient ischemic attack (TIA) in the past, are over the age of 75, or weigh less than 60 kg (132 lbs).
Ticagrelor can sometimes cause shortness of breath or a slow heart rate.
Statins
Statins are medications that help lower your low-density lipoprotein (LDL) or “bad” cholesterol. This is important because high cholesterol is a known risk factor for heart disease. These medications also reduce inflammation in your heart’s arteries. That’s why they’re usually prescribed after a heart attack, even if your cholesterol is in the normal range at baseline.
There are several statins available. Most of them are generic. Examples include:
Atorvastatin (Lipitor)
Rosuvastatin (Crestor)
Simvastatin (Zocor)
Pravastatin (Pravachol)
Fluvastatin (Lescol)
Pitavastatin (Livalo)
Most people do well with statins. But some develop muscle pain while taking them. It’s often hard to tell whether the pain is caused by the statin or something else. To learn more, a 2022 analysis compared statins with a placebo (an inactive pill). The researchers found that more than 9 out of every 10 reports of muscle pain among people taking statins weren’t caused by the medication.
That doesn’t mean you should ignore muscle pain. Let your healthcare professional know about any unexpected symptoms. If your pain may be related to your statin, your health care professional can try other treatments, including a different statin.
There’s also a rare but serious statin side effect called rhabdomyolysis. It causes muscle tissue to break down and can lead to kidney damage if left untreated. Statins can also cause liver damage, but this is rare. Regular blood testing, once or twice a year, can help pick up any signs of liver issues.
If you aren’t able to take a statin, or if a statin doesn’t lower your cholesterol enough, you have other options. These medications include:
Ezetimibe (Zetia)
PCSK9 inhibitors (like Repatha, Praluent, Leqvio, and Lipfendra)
Bempedoic acid (Nexletol)
Bile acid sequestrants, including Welchol and colestipol
If your triglycerides are high, statins can help with them, too. But if your triglycerides remain elevated, additional medications include:
Omega-3 fatty acids, like Lovaza and Vascepa
Fibrates, including fenofibrate (Antara) and gemfibrozil (Lopid)
Beta blockers
Beta blockers help lower your heart rate and reduce the impact of stress on your heart. They can also lower your blood pressure. In some cases, beta blockers can help keep your heart rhythm regular.
In the past, most people were told to take a beta blocker for at least a year after a heart attack. But newer studies suggest that long-term beta-blocker treatment may not help everyone.
If your heart is pumping normally, you may not need a beta blocker. One study also found possible harm in women with normal heart strength, especially at higher doses. More research is needed to be certain about that risk.
Here are the reasons you might need a beta blocker after a heart attack:
Your heart is weak (also known as heart failure with reduced ejection fraction)
You need a beta blocker to treat high blood pressure
You have chest pain caused by other heart blockages
You have an abnormal heart rhythm, like atrial fibrillation or premature ventricular contractions (PVCs)
Beta blockers commonly prescribed after a heart attack include:
Metoprolol succinate (Toprol XL)
Carvedilol (Coreg)
Bisoprolol (Zebeta)
Beta blockers may sometimes cause fatigue, dizziness, and erectile dysfunction. It’s also important that you don’t stop taking your beta blocker suddenly. Doing so could cause a rebound elevation of your blood pressure and heart rate. Check with your healthcare team before making any changes to your medication.
ACE inhibitors or ARBs
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are two types of medications that work in similar ways. They can help protect your heart after a heart attack. Both types of medication can lower blood pressure. If you have heart failure because your heart muscle is weak or damaged, they can help to strengthen your heart.
Examples of ACE inhibitors include:
Lisinopril (Prinivil, Zestril)
Ramipril (Altace)
Benazepril (Lotensin)
Enalapril (Vasotec)
Examples of ARBs include:
Losartan (Cozaar)
Valsartan (Diovan)
Irbesartan (Avapro)
Olmesartan (Benicar)
Candesartan (Atacand)
There are a few side effects to know about:
Up to 11% of people may get a dry cough when taking an ACE inhibitor. If you develop this side effect while taking an ACE inhibitor, an ARB is usually a better choice.
These medications usually help protect your kidneys. But they can sometimes reduce kidney function. You may need periodic blood tests to make sure your kidneys are functioning well and your potassium levels are normal.
In rare cases, people can develop angioedema while taking these medications. This is a condition that can cause life-threatening swelling in your face, throat, or tongue. If that happens, get to an emergency room immediately. Angioedema can interfere with breathing and can be fatal if not treated promptly. Angioedema is more common with ACE inhibitors, but it can also happen with ARBs.
How long do you have to take medication after having a heart attack?
You’ll likely need to take low-dose aspirin or another antiplatelet medication for life after a heart attack. This helps reduce your risk of a second heart attack. In fact, your risk may be three times higher if you stop taking your antiplatelet medication.
If you have a stent placed, you’ll probably need to take both aspirin and a P2Y12 inhibitor together for up to a year. Taking both medications will help to prevent a blood clot from forming in your stent.
Statins and other cholesterol-lowering medications are also important for preventing future heart problems. Of course, medical science keeps advancing, so there may be other options in the future.
If your heart muscle is damaged, beta blockers, ACE inhibitors, and ARBs can help it recover. Depending on your blood pressure and other conditions, you may need one or more of these medications for life.
What happens if you stop taking them?
It’s critical to stay on your antiplatelet medications after a heart attack, including aspirin. Your cardiologist will let you know when it’s time to change the dose or switch to a different medication.
If you stop taking your antiplatelet medications in the first several months after getting a stent, your stent may get blocked by a blood clot. This will cause a heart attack and can be fatal.
Before surgery or another procedure, a healthcare professional may ask you to stop taking aspirin for several days. But it’s important to check with your cardiologist before you stop, especially if you recently had a heart attack or stent placed.
Your other medications are also important. For example:
If you stop taking your beta blocker, ACE inhibitor, or ARB, your blood pressure could rise.
If you have heart failure, stopping the above medications can reverse your progress and weaken your heart. That can happen even months or years later.
If you stop your cholesterol medication, it may also raise your risk of having another heart attack in the future.
Frequently asked questions
Common heart failure medications include:
Beta blockers
ACE inhibitors, ARBs, or angiotensin receptor-neprilysin inhibitor (ARNIs) like Entresto
Aldosterone blockers, such as spironolactone or eplerenone
Sodium-glucose cotransporter-2 (SGLT2) inhibitors, like Jardiance or Farxiga
Diuretics, also called water pills
There are two common “little pills” that are often given for a heart attack:
Aspirin, which helps keep a blood clot from growing
Nitroglycerin, which widens blood vessels and may ease chest pain
If you think you’re having a heart attack, call 911 first. These medications can be taken before you reach the hospital, but they aren’t a substitute for medical care. If you’re allergic to aspirin, don’t take it. If you’ve recently taken medication for erectile dysfunction, you should avoid nitroglycerin.
After you get to the ER, your healthcare team will work quickly to restore blood flow to your heart. This often means placing a stent in the blocked heart artery. Most people stay in the hospital a couple days as their heart recovers. You may need a few more days depending on the severity of your heart attack. During that time, your team will start you on medicines to protect your heart and prevent another heart attack. Most people return home to continue their recovery. You’ll likely enroll in cardiac rehab and follow up closely with your cardiologist.
Common heart failure medications include:
Beta blockers
ACE inhibitors, ARBs, or angiotensin receptor-neprilysin inhibitor (ARNIs) like Entresto
Aldosterone blockers, such as spironolactone or eplerenone
Sodium-glucose cotransporter-2 (SGLT2) inhibitors, like Jardiance or Farxiga
Diuretics, also called water pills
There are two common “little pills” that are often given for a heart attack:
Aspirin, which helps keep a blood clot from growing
Nitroglycerin, which widens blood vessels and may ease chest pain
If you think you’re having a heart attack, call 911 first. These medications can be taken before you reach the hospital, but they aren’t a substitute for medical care. If you’re allergic to aspirin, don’t take it. If you’ve recently taken medication for erectile dysfunction, you should avoid nitroglycerin.
After you get to the ER, your healthcare team will work quickly to restore blood flow to your heart. This often means placing a stent in the blocked heart artery. Most people stay in the hospital a couple days as their heart recovers. You may need a few more days depending on the severity of your heart attack. During that time, your team will start you on medicines to protect your heart and prevent another heart attack. Most people return home to continue their recovery. You’ll likely enroll in cardiac rehab and follow up closely with your cardiologist.
The bottom line
After you have a heart attack, you may leave the hospital with several new prescriptions. These can include antiplatelet medications, cholesterol-lowering medications, and blood pressure medications. It’s normal to have questions and concerns about your treatment plan.
Each medication has a different role in helping your heart recover and keeping it strong. If you have side effects, it’s good to know that there are a wide range of options. Your healthcare team can develop a treatment plan that works for you. By taking your medications as prescribed, you’ll have the best chance of making a good recovery and staying well.
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