Several Questions About Meds After Prior Heart Attack

[BabsD]

I am a 39 year old female with a history of a prior silent heart attack.I was diagnosed after a routine ekg and echo were abnormal, and I had a heart cath that showed an area on my heart that was not moving due to a prior heart attack, but normal coronary arteries and an EF of 45-50. After extensive testing, no cause has ever been determined, although the theory is that it may have been caused by a blood clot due to birth control pills I was on. My blood pressure is normal,and I have no clotting disorders or other health issues,but I'm overweight.
I currently take 81mg aspirin, 25mg atenolol, and 1mg folic acid daily, as well as 1 fish oil capsule and a multivitamin. My cardiologist now wants me to take an Ace Inhibitor as well as a statin to lower my cholesterol, which is: tot chol 200, LDL 143, HDL 43, Trig. 69.
I'm not sure why I need an ace inhibitor-the doc just said that it was the new protocol to follow in people with a history of MI. Why would an ace inhibitor be needed for me? Which ace inhibitor would you recommend, and what side-effects could I expect? Also, I am worried about starting a statin after reading posts about statins causing cardiomyopathy and other problems. Do I really need to start these meds?  I really don't want to take anything more unless absolutely necessary, and I'm afraid of side-effects.  I have postponed my followup visit while I think about what I want to do.
I now exercise 3-4 times a week, although I am still 40 lbs overweight, and I have just started the South Beach Diet (low-carb).  Any info or advice would be greatly appreciated.

[CCF-M.D.-RCJ]

BabsD,

Thanks for the post.

Q:"Why would an ace inhibitor be needed for me?"

From the HOPE trial, published around 1998 in NEJM, an ACE-inhibitor was shown to decrease mortality in patients with risk factors for CAD.  Multiple trials have shown that patients with coronary artery disease and low EF derive mortality benefit from ACE-inhibitors.  The story you wrote does not exactly fit either of those scenarios, but an ACE-inhibitor is certainly reasonable therapy.

Q:"which ace inhibitor would you recommend, and what side-effects could I expect?

Whichever one was cheapest for you.  A minority of persons develop a cough.  Kidney problems can develop in selected populations.

Q:"Do I really need to start these meds [statins]?

Statins have proven mortality benefit in persons with coronary artery disease.  The decision to start them or not belongs to you.

Q:"Any info or advice would be greatly appreciated."

Losing weight and exercise has a huge impact on a person's quality of life and life expectancy.  Keep up the good work.

[Dr. Erik]

Your HDL is kind of low with your other cholesterol numbers which gives you a Ratio of 4.6 . You want to get that down to 3.5 for better protection. Don't worry about the prior posts about Statins causing Cardiomyopathy. It is a bunch of B.S. Some quack doctor down in Texas reported this effect to try and sell some Coenzyme Q10 supplements. I was scared myself when I read it because I take Zocor. If it makes you feel better you can take some Coenzyme Q10, with your doctor's blessing of course. The medicines your doctor is putting you on are excellent. He is being agressive in preventing any further problems. That should make you happy. Pluto is absolutley right about the Ace Inhibitor. Follow your doctor's advice. Raise that HDL also. It should increase with exercise and further weight loss. Good luck!

[knicks30]

Sorry to hear about your heart attack at such a young age. They said it was because of a blood clot due to you being on birth control pills? I have never heard such a thing being that so many women are on birth control pills. Did they ever look into coronary artery spasms?

Anywayz, what causes coronary artery spasms?? I always wondered that and how is it diagnosed?

Since your arteries are clear which is good just like the doc said is to avoid getting those arteries clogged and just be healthy and i doubt youll have another heart attack again.

True Blessings