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

Area of Science:

• Pharmacology
• Cardiology
• Primary Care Medicine

Background:

• Second-generation antipsychotics (SGAs) are widely prescribed by primary care physicians (PCPs) for various psychiatric conditions.
• SGAs are linked to adverse cardiovascular effects, yet evidence-based guidance for PCPs on managing this risk is lacking.
• This project addresses the need for recommendations on SGAs and cardiotoxicity tailored for primary care.

Purpose of the Study:

• To develop evidence-based recommendations for PCPs regarding the use of SGAs and their associated cardiovascular risks.
• To synthesize current evidence on the cardiotoxicity of SGAs.
• To provide practical guidance for risk assessment and management in primary care settings.

Main Methods:

• A systematic literature search was conducted using terms related to SGAs and cardiovascular disease in PubMed, PubMed Central, and AccessMedicine.
• Systematic reviews and meta-analyses were prioritized and assessed for quality using the Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool.
• High and moderate quality studies were used to formulate recommendations for PCPs.

Main Results:

• Seven systematic reviews and meta-analyses met the quality criteria.
• SGAs were associated with adverse cardiac events, including QT interval prolongation, arrhythmias, myocardial infarction, and tachycardia.
• Cardio-metabolic morbidities were also identified as potential risks.

Conclusions:

• Cardiovascular risks are associated with SGAs, necessitating screening and monitoring for cardiac toxicities.
• The benefits of SGAs generally outweigh the risks for most patients.
• Effective risk reduction strategies for SGAs can be implemented within primary care.