Antipsychotic drug exposure and risk of myocardial infarction

Barbui, Corrado; Gastaldon, Chiara; Papola, Davide; Ostuzzi, Giovanni

doi:10.1017/s204579601600086x

Cited by 4 publications

(3 citation statements)

References 21 publications

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“… 17 IHD is one of the side effects found to be linked to the use of antipsychotics in the general population. 18 , 19 In vivo and in vitro pharmacological studies suggested that the link between antipsychotics and cardiovascular side events is possibly due to the metabolic side effects of antipsychotics, 20 blockade of dopamine type 3 receptors, 21 defect in cardiovascular and immunological factors such as brain derived neurotrophic factor (BDNF) and platelet derived growth factor receptor (PDGFR)-beta, 22 altered cardiac mitochondrial oxygen consumption, 23 or immunosuppression and leukocyte accumulation in the arterial wall. 24 However, this link has not been epidemiologically confirmed.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Events Associated with Antipsychotics in Newly Diagnosed Parkinson’s Disease Patients: A Propensity Score Matched Cohort Study

Orayj

2021

IJGM

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Purpose Observational studies have examined the association between antipsychotics and ischemic heart disease (IHD) in general populations, but results did not take into account other comorbid diseases, such as Parkinson’s disease (PD). This study investigates the one-year risk of IHD, all cardiovascular events, and all-cause mortality among newly diagnosed PD patients who used antipsychotics compared to non-users. Materials and Methods This study included individuals aged 40 years or older with a first definitive PD diagnosis Read Code in the Secure Anonymised Information Linkage (SAIL) databank who had been initiated on any PD medication between 2000 and 2016. Antipsychotic users were matched 1:1 with non-users by a propensity score model to control the confounding effects of patients’ demographics, social deprivation status, comorbidities, and medication history. Cox regression was performed to calculate the hazard ratios (HR) and 95% CIs for the association between antipsychotics and study outcomes. Results A total of 1837 participants were included in the analysis. Users of first-generation antipsychotics (FGA) were significantly more likely to develop IHD compared to non-users, with an HR of 2.60 (95% CI 1.103–6.167). Among the FGAs, haloperidol had the highest likelihood of IHD developing, with an HR of 3.01 (95% CI 1.038–8.729). Any use of antipsychotics, regardless of whether they were FGA or second-generation antipsychotics (SGA), was linked to all-cause mortality, with an HR of 4.201 (95% CI 3.272–5.394). When subdividing antipsychotics into FGAs and SGAs, mortality was more likely in FGA users, with an HR of 7.557 (95% CI 5.633–10.139). Mortality also occurred in SGA users, but with a lower HR of 3.278 (95% CI 2.509–4.282). Conclusion FGAs were associated with an increased risk of IHD and all-cause mortality in newly diagnosed PD patients with psychosis. This finding emphasizes the need to use antipsychotics with caution in PD patients with psychosis.

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Section: Introductionmentioning

confidence: 99%

Cardiovascular Events Associated with Antipsychotics in Newly Diagnosed Parkinson’s Disease Patients: A Propensity Score Matched Cohort Study

Orayj

2021

IJGM

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“…Antipsychotic medications commonly prescribed for patients with a variety of mental disorders such as schizophrenia, bipolar disorder, and dementia are generally believed to entail a heightened risk of acute ischemic heart disease (IHD) [ 1 ]. However, meta-analyses have reported conflicting results on this association [ 2 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Association between antipsychotic use and acute ischemic heart disease in women but not in men: a retrospective cohort study of over one million primary care patients

Lai

Guthrie

Mercer

et al. 2020

BMC Med

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Background Research comparing sex differences in the effects of antipsychotic medications on acute ischemic heart disease (IHD) is limited and the findings ambiguous. This study aimed to investigate these associations within a primary care setting. Methods Hong Kong public general outpatient electronic records of patients aged 45+ during 2007–2010 were extracted, with the last consultation date as the baseline for a 4-year follow-up period to observe acute IHD hospitalizations (2011–2014). Antipsychotic use was defined as any prescription over the previous 12 months from a list of 16 antipsychotics, while acute IHD was defined by ICD-9: 410.00–411.89. Both sex-specific and sex-combined (both sexes) mixed-effects Cox models (random intercept across 74 clinics) were implemented to examine the association and test the interaction between antipsychotics and sex. Results Among 1,043,236 included patients, 17,780 (1.7%) were prescribed antipsychotics, and 8342 (0.8%) developed IHD. In sex-specific analyses, antipsychotic prescription was associated with a 32% increased hazard rate of acute IHD among women (95% CI 1.05–1.67) but not among men. A likelihood ratio test comparing sex-combined models with and without the interaction between antipsychotic use and sex suggested significant interaction (χ2 = 4.72, P = 0.030). The association between antipsychotic use and IHD among women attenuated and became non-significant when haloperidol was omitted from the operationalization of antipsychotic use (HR = 1.23, 95% CI 0.95–1.60). Conclusion Our results suggest that antipsychotic prescription is moderately associated with an increased risk of acute IHD among women in primary care and this relationship may be explained by specific antipsychotics. Further research should observe and capture the potential intermediary mechanisms and the dose-response relationship of this association to provide more rigorous evidence to establish causality and inform clinical practices.

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“…The study of safety and tolerability outcomes associated with exposure to psychotropic medicines remains a challenging issue. While for efficacy outcomes it is widely accepted that randomised controlled trials (RCTs) represent the most reliable and appropriate reference standard, for safety and tolerability outcomes individual RCTs may not provide satisfactory information (Barbui et al ., 2017 a ). This is especially the case for psychotropic medicines: for uncommon or rare safety outcomes, RCTs are usually underpowered to establish associations; for unexpected safety outcomes, RCTs may not have planned to systematically collect information on that outcome; for safety outcomes not occurring immediately after the intervention is provided, RTCs may be too short in duration.…”

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confidence: 99%