It is remarkable how many patients with proven evidence of coronary artery disease or who have had a heart attack are not appropriately treated with medications that are proved to reduce the risk of further heart attacks or the development of heart failure, which is the major cause of death in men and women.

All of the recommended medications are available as generics (now costing only $10 for a three-month supply at virtually every pharmacy) and include simvistatin to reduce cholesterol; lisinopril, an ACE inhibitor used to protect cardiac muscle, and atenolol, a beta blocker that slows the heart rate.

These drugs should be prescribed not only for patients who have had a heart attack, but also for those who have symptoms of coronary artery disease such as chest pain (angina) or shortness of breath caused by impaired blood supply to the heart. Treatment should also be considered if a routine EKG shows evidence of coronary artery disease, even if the patient has never had any symptoms. These patients may have had a so-called silent heart attack and are at as great a risk of having a second heart attack as those who have been hospitalized with symptomatic disease.

Experience with beta blockers in preventing heart attacks spans four decades. There is not much that we do not know about these drugs. And of all the beta blockers currently available, the most frequently used is atenolol. This drug has clearly been shown to be most effective in preventing a recurrent heart attack by 50 percent or more. The mechanism of action is slowing the heart rate, preventing heart rate irregularities and reducing the heart's requirement for oxygen. The greater the slowing of the heart, the greater the cardioprotective effect of atenolol. Research has also shown that administration of atenolol or other beta blockers during an acute heart attack reduces the risk of death by 13 percent. Atenolol is also recommended for any patient at high risk of coronary artery disease who is undergoing a major surgical procedure. Given perioperatively, atenolol reduces the risk of a heart attack by 56 percent and of cardiac death by 67 percent.

Atenolol is also the most common medication used to treat high blood pressure, accounting for the vast majority of the 44 million prescriptions for this drug that are written annually. Current state of the art approaches to treating mild elevation of blood pressure should first involve restricting salt in the diet, exercise and prudent weight loss. If this is insufficient most physicians would then consider either hydrocholorothiazide, a water pill that helps reduce total body sodium levels and/or atenolol that, in addition to all its effects described above, also lowers blood pressure.

While atenolol does lower blood pressure, a recent review published in the Journal of the American College of Cardiology raised serious questions about the use of this drug and many other beta blockers in the treatment of hypertension. Here, although atenolol lowered the heart rate and blood pressure, the risk of heart attacks, heart failure and death were increased rather than decreased.

In an accompanying editorial Dr. Norman Kaplan stated that while it is still appropriate to use beta blockers in general and atenolol in particular in the prevention of heart attacks and heart failure, it should no longer be used to treat high blood pressure.

To a physician, this information is truly remarkable. Like the vast majority of my colleagues, I would have considered atenolol highly effective and appropriate for the treatment of high blood pressure.

So often many patients who read this or other articles that describe the adverse effect of a medication automatically stop taking the drug without consulting their physician. In the case of the beta blockers, sudden discontinuation of this drug can have disastrous effects. Blood pressure can rise substantially, heart rate irregularities can occur, as can a heart attack. If a decision is made to discontinue atenolol, the dose must be gradually tapered. Before taking any action, please question your physician to make sure that this drug is indeed right for you.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

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