Second Generation Antipsychotics and Cardiovascular Adverse Effects: Developing Evidence-Based Recommendations for...

Second-generation antipsychotic medications (SGAs) are often used by primary care physicians (PCPs) to treat multiple psychiatric diagnoses. SGAs have been connected to a number of adverse effects, including cardiovascular disease. Currently, there are no published evidence-based recommendations addressing SGAs and cardiotoxicity that are directed toward PCPs. This project aims to fill this gap.

Relevant search terms related to SGAs and cardiovascular disease were identified and then used to search databases (PubMed, PubMed Central, and AccessMedicine). Research studies obtained from the searches were narrowed to include systematic reviews and meta-analyses. The Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool was utilized by 2 investigators to evaluate the quality of the research independently. Research rated by both investigators to be of high and moderate quality using the AMSTAR-2 system was employed to develop recommendations for PCPs when using SGAs with their patients.

Seven systematic reviews and meta-analyses were found to be of high or moderate quality by AMSTAR-2 evaluations. The studies identified associations between SGAs and a number of adverse cardiac conditions, including corrected QT interval (QTc) prolongation, arrhythmias, myocardial infarction, tachycardia, and other cardio-metabolic associated morbidities.

Our project indicated that cardiovascular risks can be associated with SGAs and that screening and monitoring for cardiac toxicities are indicated when treating patients with this class of medications. These risks, however, do not appear to override benefits in most patients. Furthermore, it appears that when using SGAs, methods of risk reduction can be applied effectively in the primary care setting.