Familiarity with the top 300 prescription drugs dispensed by U.S. community pharmacies provides an insight into prevailing disease trends in the U.S. population. Predicated on the mechanisms of action of cardiovascular drugs in the top 300, the most common cardiovascular diseases include HTN, IHC (i.e., chronic CAD and ACS), cardiac arrhythmias, heart failure, and thromboembolic complications.
The risk of a major adverse cardiac event (MACE), i.e., myocardial infarction, heart failure, and sudden cardiac death, with advanced age, atrial fibrillation, stroke, uncontrolled HTN, chronic stable angina pectoris, previous MI (>60 days), Class I HF, diabetes mellitus, and renal insufficiency in association with low surgical stress, e.g., dental procedures under local dental anesthesia, is very low to low.
The risk of MACE with acute coronary syndromes, i.e., unstable angina pectoris and recent MI (<60 days), Class II, III, and IV HF, sever valvular disease, and significant arrhythmia, i.e., supraventricular arrhythmias with uncontrolled ventricular rate, high-grade AV bloc, and symptomatic ventricular arrhythmias in the presence of underlying heart disease is elevated independent of surgical stress.
Before elective dental care, estimate the patient’s perioperative risk for MACE. If the combined procedure- and patient-specific variables predict low-risk for MACE and the patient’s FC is ≥4 METs no further preoperative evaluation may be needed. If the FC is <4 METs and/or the risk for MACE is elevated, before initiating any elective dental care, the patient should undergo medical evaluation.