Cardiovascular adverse effects of psychotropics: What to look for

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Cardiovascular adverse effects of psychotropics: What to look for

Most patients who take psychotropic medications are at low risk for cardiovascular adverse effects from these medications, and require only routine monitoring. However, patients with severe mental illness, those with a personal or family history of cardiovascular disease, or those receiving high doses or multiple medications are considered at high risk for morbidity and mortality from cardiovascular adverse effects. Such patients may need more careful cardiovascular monitoring.

To help identify important cardiovascular-related adverse effects of various psychotropics, we summarize these risks, and offer guidance about what you can do when your patient experiences them (Table).1

Cardiovascular adverse effects of psychotropic medications

Antipsychotics and metabolic syndrome

Patients who take antipsychotics should be monitored for metabolic syndrome. The presence of 3 of the following 5 para­meters is considered positive for metabolic syndrome2:

  • fasting glucose ≥100 mg/dL or hemoglobin A1c ≥5.6%
  • blood pressure ≥130/85 mm Hg
  • triglycerides ≥150 mg/dL
  • high-density lipoprotein cholesterol
  • waist circumference ≥102 cm in men or ≥88 cm in women.
 

Stimulants and sudden cardiac death

Sudden cardiac death (SCD) in children and adolescents who take stimulants to treat attention-deficit/hyperactivity disorder is rare. For these patients, the risk of SCD is no higher than that of the general population.3 For patients who do not have any known cardiac risk factors, the American Academy of Pediatrics does not recommend performing any cardiac tests before starting stimulants.3

References

1. Mackin P. Cardiac side effects of psychiatric drugs. Hum Psychopharmacol. 2008;23(suppl 1):S3-S14.
2. Grundy SM, Brewer HB Jr, Cleeman JI, et al; National Heart, Lung, and Blood Institute; American Heart Association. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Arterioscler Thromb Vasc Biol. 2004;24(2):e13-e18.
3. American Academy of Pediatrics Steering Committee on Quality Improvement and Management. Classifying recommendations for clinical practice guidelines. Pediatrics. 2004;114(3):874-877.

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Dr. Majeed is Attending Psychiatrist, Natchaug Hospital, Mansfield Center, Connecticut. Dr. Khalil is a PGY-1 resident, Department of Family Medicine, WellSpan Good Samaritan Hospital, Lebanon, Pennsylvania.

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The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.

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Dr. Majeed is Attending Psychiatrist, Natchaug Hospital, Mansfield Center, Connecticut. Dr. Khalil is a PGY-1 resident, Department of Family Medicine, WellSpan Good Samaritan Hospital, Lebanon, Pennsylvania.

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The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.

Author and Disclosure Information

Dr. Majeed is Attending Psychiatrist, Natchaug Hospital, Mansfield Center, Connecticut. Dr. Khalil is a PGY-1 resident, Department of Family Medicine, WellSpan Good Samaritan Hospital, Lebanon, Pennsylvania.

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The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.

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Most patients who take psychotropic medications are at low risk for cardiovascular adverse effects from these medications, and require only routine monitoring. However, patients with severe mental illness, those with a personal or family history of cardiovascular disease, or those receiving high doses or multiple medications are considered at high risk for morbidity and mortality from cardiovascular adverse effects. Such patients may need more careful cardiovascular monitoring.

To help identify important cardiovascular-related adverse effects of various psychotropics, we summarize these risks, and offer guidance about what you can do when your patient experiences them (Table).1

Cardiovascular adverse effects of psychotropic medications

Antipsychotics and metabolic syndrome

Patients who take antipsychotics should be monitored for metabolic syndrome. The presence of 3 of the following 5 para­meters is considered positive for metabolic syndrome2:

  • fasting glucose ≥100 mg/dL or hemoglobin A1c ≥5.6%
  • blood pressure ≥130/85 mm Hg
  • triglycerides ≥150 mg/dL
  • high-density lipoprotein cholesterol
  • waist circumference ≥102 cm in men or ≥88 cm in women.
 

Stimulants and sudden cardiac death

Sudden cardiac death (SCD) in children and adolescents who take stimulants to treat attention-deficit/hyperactivity disorder is rare. For these patients, the risk of SCD is no higher than that of the general population.3 For patients who do not have any known cardiac risk factors, the American Academy of Pediatrics does not recommend performing any cardiac tests before starting stimulants.3

Most patients who take psychotropic medications are at low risk for cardiovascular adverse effects from these medications, and require only routine monitoring. However, patients with severe mental illness, those with a personal or family history of cardiovascular disease, or those receiving high doses or multiple medications are considered at high risk for morbidity and mortality from cardiovascular adverse effects. Such patients may need more careful cardiovascular monitoring.

To help identify important cardiovascular-related adverse effects of various psychotropics, we summarize these risks, and offer guidance about what you can do when your patient experiences them (Table).1

Cardiovascular adverse effects of psychotropic medications

Antipsychotics and metabolic syndrome

Patients who take antipsychotics should be monitored for metabolic syndrome. The presence of 3 of the following 5 para­meters is considered positive for metabolic syndrome2:

  • fasting glucose ≥100 mg/dL or hemoglobin A1c ≥5.6%
  • blood pressure ≥130/85 mm Hg
  • triglycerides ≥150 mg/dL
  • high-density lipoprotein cholesterol
  • waist circumference ≥102 cm in men or ≥88 cm in women.
 

Stimulants and sudden cardiac death

Sudden cardiac death (SCD) in children and adolescents who take stimulants to treat attention-deficit/hyperactivity disorder is rare. For these patients, the risk of SCD is no higher than that of the general population.3 For patients who do not have any known cardiac risk factors, the American Academy of Pediatrics does not recommend performing any cardiac tests before starting stimulants.3

References

1. Mackin P. Cardiac side effects of psychiatric drugs. Hum Psychopharmacol. 2008;23(suppl 1):S3-S14.
2. Grundy SM, Brewer HB Jr, Cleeman JI, et al; National Heart, Lung, and Blood Institute; American Heart Association. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Arterioscler Thromb Vasc Biol. 2004;24(2):e13-e18.
3. American Academy of Pediatrics Steering Committee on Quality Improvement and Management. Classifying recommendations for clinical practice guidelines. Pediatrics. 2004;114(3):874-877.

References

1. Mackin P. Cardiac side effects of psychiatric drugs. Hum Psychopharmacol. 2008;23(suppl 1):S3-S14.
2. Grundy SM, Brewer HB Jr, Cleeman JI, et al; National Heart, Lung, and Blood Institute; American Heart Association. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Arterioscler Thromb Vasc Biol. 2004;24(2):e13-e18.
3. American Academy of Pediatrics Steering Committee on Quality Improvement and Management. Classifying recommendations for clinical practice guidelines. Pediatrics. 2004;114(3):874-877.

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