Li Xiao-Qing, Tang Xin-Ru, Li Li-Liang
Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China.
World J Psychiatry. 2021 Oct 19;11(10):736-753. doi: 10.5498/wjp.v11.i10.736.
Chronic use of antipsychotic medications entails a dilemma between the benefit of alleviating psychotic symptoms and the risk of troubling, sometimes life-shortening adverse effects. Antipsychotic-induced cardiotoxicity is one of the most life-threatening adverse effects that raises widespread concerns. These cardiotoxic effects range from arrhythmia to heart failure in the clinic, with myocarditis/cardiomyopathy, ischemic injuries, and unexplained cardiac lesions as the pathological bases. Multiple mechanisms have been proposed to underlie antipsychotic cardiotoxicity. This review aims to summarize the clinical signs and pathological changes of antipsychotic cardiotoxicity and introduce recent progress in understanding the underlying mechanisms at both the subcellular organelle level and the molecular level. We also provide an up-to-date perspective on future clinical monitoring and therapeutic strategies for antipsychotic cardiotoxicity. We propose that third-generation antipsychotics or drug adjuvant therapy, such as cannabinoid receptor modulators that confer dual benefits - , alleviating cardiotoxicity and improving metabolic disorders - deserve further clinical evaluation and marketing.
长期使用抗精神病药物会带来一种两难境地，即在缓解精神症状的益处与令人困扰、有时甚至会缩短寿命的不良反应风险之间进行权衡。抗精神病药物引起的心脏毒性是最危及生命的不良反应之一，引发了广泛关注。在临床上，这些心脏毒性作用从心律失常到心力衰竭不等，其病理基础为心肌炎/心肌病、缺血性损伤和不明原因的心脏病变。已经提出了多种机制来解释抗精神病药物的心脏毒性。本综述旨在总结抗精神病药物心脏毒性的临床体征和病理变化，并介绍在亚细胞器水平和分子水平上理解其潜在机制的最新进展。我们还提供了关于抗精神病药物心脏毒性未来临床监测和治疗策略的最新观点。我们认为，第三代抗精神病药物或药物辅助治疗，如具有双重益处（减轻心脏毒性和改善代谢紊乱）的大麻素受体调节剂，值得进一步的临床评估和推广。
