Your significant role in modifying risk factors for coronary artery disease and managing problems subsequently
Be familiar with patients’ medical problems, routine cardiac meds, and drug−drug interactions
At this point, the psychiatrist starts metformin to prevent T2DM. He also starts Ms. S on a statin to prevent CAD in a setting of diagnosed T2DM.
Ms. S’s exertional dyspnea and shoulder discomfort could be associated with angina, and the physician wisely refers her for urgent evaluation. Because he is aware of the literature demonstrating decreased revascularization among patients with mental illness, he urges her other health care providers to provide her with guideline-based strategies to treat her cardiovascular disease.
Bottom Line
Patients with psychiatric illness have higher rates of morbidity and mortality from coronary artery disease (CAD) than the general population. Symptoms characteristic of depression and schizophrenia could lead to poor self-care or impaired adherence to programs designed to lower CAD risk factors. Institute strategies for primary and secondary prevention of CAD among your patients, based on published guidelines, and be aware of, and alert for, adverse cardiac effects and an increase in risk factors for CAD from the use of psychotropics.
Related Resources
• Elderon L, Whooley MA. Depression and cardiovascular disease. Prog Cardiovasc Dis. 2013;55(6):511-523.
• Interactive cardiovascular risk calculator developed from the Framingham Heart Study. https://www.framingham heartstudy.org/risk-functions/cardiovascular-disease/ 10-year-risk.php.
• Pooled Cohort Equations calculator. To determine estimated cardiovascular risk in comparison with peers with optimized risk factors. https://clincalc.com/cardiology/ascvd/ pooledcohort.aspx.
• To learn more about traditional cardiovascular risk factors from the Framingham Heart Study. https://www.framinghamheart study.org/risk-functions/.
Drug Brand Names
Amlodipine • Norvasc
Clozapine • Clozaril
Clopidogrel • Plavix
Felodipine • Plendil
Fluoxetine • Prozac
Fluvoxamine • Luvox
Lithium • Eskalith, Lithobid
Metformin • Glucophage
Olanzapine • Zyprexa
Risperidone • Risperdal
Disclosure
The author reports no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.
