Cardiovascular Effects of Noncardiovascular Drugs

Abstract

Most drugs are not used to treat heart disease. However, such “noncardiovascular” medications can often have cardiovascular effects. In this review, we discuss some cardiovascular manifestations of drugs used for noncardiovascular indications. We discuss these in the text according to the manifestations with which patients present; selected drugs are listed in Table 1 by their indication/drug class. The same medication may appear in different sections, reflecting the varied cardiovascular consequences of a particular drug. We also discuss cardiovascular effects of noncardiovascular drugs that arise indirectly from drug interactions that cause an increase or decrease in the concentration of a cardiovascular drug. View this table: Table 1. Selected Noncardiovascular Drugs With Cardiovascular Effects by Indication/Drug Class ### Atrial Fibrillation Most reports of atrial fibrillation (AF) induced by noncardiovascular drugs are case reports, and because AF is so common, it is difficult to determine whether the association is causal or incidental. The ability to reproduce AF with drug rechallenges supports causality, as does a mechanistic rationale. Table 1 lists drugs with a well-established association with AF. After numerous case reports of the onset of AF after pulse methylprednisolone, van der Hooft et al1 conducted a nested case-control study in the Rotterdam study that comprised almost 8000 adults. They found that high-dose corticosteroid use (≥7.5 mg prednisone equivalents) was associated with a significantly increased risk of new-onset AF (odds ratio [OR]=6.1; 95% confidence interval [CI], 3.9 to 9.4) but that low-dose corticosteroid use was not associated with AF (OR=1.4; 95% CI, 0.7 to 2.8). This increase in AF risk was seen with all indications for high-dose corticosteroids. It has been postulated that high-dose corticosteroids might mediate cellular potassium efflux and that this may in turn predispose to arrhythmia.2 There is concern that bisphosphonates may increase the risk of serious AF (AF resulting in hospitalization or disability or …