Long-Term Antipsychotic Use and Major Cardiovascular Events

Szmulewicz, Alejandro G.; Angriman, Federico; Pedroso, Felipe E.; Vázquez, Carolina; Martino, Diego Javier

doi:10.4088/jcp.16m10976

Cited by 18 publications

(18 citation statements)

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“…Many APDs currently available in the United States have been associated with metabolic side effects to varying degrees (Kendall, 2011 ). Clozapine and olanzapine, though the most clinically effective APDs available, have also shown the greatest risk for inducing IR and significantly elevate risks for major cardiovascular events (e.g., acute coronary syndrome, ischemic stroke, and peripheral artery disease) by up to 2.8-fold (Szmulewicz et al, 2017 ). Indeed, 32% of patients taking olanzapine develop IR, in addition to gaining at least 15% of their baseline bodyweight (Citrome et al, 2011 ).…”

Section: Contribution Of Antipsychotic Medications To Metabolic Riskmentioning

confidence: 99%

Intrinsic and Antipsychotic Drug-Induced Metabolic Dysfunction in Schizophrenia

et al. 2017

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For decades, there have been observations demonstrating significant metabolic disturbances in people with schizophrenia including clinically relevant weight gain, hypertension, and disturbances in glucose and lipid homeostasis. Many of these findings pre-date the use of antipsychotic drugs (APDs) which on their own are also strongly associated with metabolic side effects. The combination of APD-induced metabolic changes and common adverse environmental factors associated with schizophrenia have made it difficult to determine the specific contributions of each to the overall metabolic picture. Data from drug-naïve patients, both from the pre-APD era and more recently, suggest that there may be an intrinsic metabolic risk associated with schizophrenia. Nevertheless, these findings remain controversial due to significant clinical variability in both psychiatric and metabolic symptoms throughout patients' disease courses. Here, we provide an extensive review of classic and more recent literature describing the metabolic phenotype associated with schizophrenia. We also suggest potential mechanistic links between signaling pathways associated with schizophrenia and metabolic dysfunction. We propose that, beyond its symptomatology in the central nervous system, schizophrenia is also characterized by pathophysiology in other organ systems directly related to metabolic control.

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Section: Contribution Of Antipsychotic Medications To Metabolic Riskmentioning

confidence: 99%

Intrinsic and Antipsychotic Drug-Induced Metabolic Dysfunction in Schizophrenia

et al. 2017

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“…Although the results of lithium reducing the risk of stroke in BD patients remains conflicting, 37,38 it is well known that older adult patients under antipsychotic regimens may face an increasing incidence of major cardiovascular events during long-term follow-up. 39 The duration of either antipsychotic or lithium treatment is comparable in these two group. Therefore, our data could not find the effect of psychotropic agents on the risk of stroke.…”

Section: Discussionmentioning

confidence: 85%

“…Parameters for treatment including age at the last psychiatric visit, age at the first and the last acute psychiatric admissions, number of lifetime acute psychiatric admissions, and duration of antipsychotics and lithium treatment were not significantly different between these two groups. Although the results of lithium reducing the risk of stroke in BD patients remains conflicting, it is well known that older adult patients under antipsychotic regimens may face an increasing incidence of major cardiovascular events during long‐term follow‐up . The duration of either antipsychotic or lithium treatment is comparable in these two group.…”

Section: Discussionmentioning

confidence: 99%

High risk of silent stroke in older bipolar patients with typical‐onset age

et al. 2019

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Aim Older patients with bipolar disorder (BD) are at a high risk of stroke. Silent stroke could be neglected in BD patients after middle age, particularly in those with illness onset at the young age. Therefore, we investigated the morbidity and related factors for stroke in older BD patients with typical‐onset age. Methods Older patients with bipolar I disorder (age > 50 years) and their illness onset prior to the age of 40 years were recruited. After whole‐brain magnetic resonance imaging was conducted, the patients were divided into stroke and non‐stroke groups. Clinical data were obtained by reviewing all available medical records and directly interviewing the patients along with their reliable family members. Results We recruited 62 patients with a mean age of 60.4 years and illness onset at the mean age of 28.4 years. Cerebral infarction or old stroke was observed in 24 (38.7%) patients, including 22 without any reported clinical history of stroke. That is, silent stroke (n = 22) was detected in 36.7% of 60 patients without clinical history of stroke. The stroke group had significantly higher mean numbers of lifetime mood episodes (P = 0.006) than the non‐stroke one. Logistic regression analysis showed that 10 or more prior mood episodes (odds ratio = 3.43, 95% confidence interval = 1.12–10.47, P < 0·04) was significantly associated with the occurrence of stroke. The two study groups did not exhibit any other differences in demographic and clinical variables, such as age, laboratory or physical measurements during the last acute psychiatric hospitalisation, body mass index, and substance use problems and concurrent medical diseases. Conclusions High morbidity of stroke, particularly silent stroke, could be found in older bipolar patients with typical‐onset age. In addition to traditional risk factors, the number of recurrent mood episodes in a lifetime may increase the risk of stroke in older BD patients.

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“…Poorer secondary prevention has been shown previously in ischemic heart disease (16), and a study from the US reported that the Framingham 10-year risk of coronary heart disease was increased by 79% in patients with schizophrenia (9). One potential driver of poorer cardiovascular health in these patients could be the cardiovascular side effects of antipsychotic drugs (13, 22).…”

Section: Discussionmentioning

confidence: 99%

“…Circulatory disease is one of the major causes of excess death in people with psychiatric disorders, second to suicide (10, 11). This may be due to several factors, including lifestyle, poor identification and management of risk factors and the disease itself, lack of health literacy, and side effects of antipsychotic medication (8, 12), which may further increase the risk of cardiovascular events (13).…”

Section: Introductionmentioning

confidence: 99%

The Association of Pre-stroke Psychosis and Post-stroke Levels of Health, Resource Utilization, and Care Process: A Register-Based Study

et al. 2018

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Background: While approximately one percent of the global population is formally diagnosed with psychosis or schizophrenia, the actual number is expected to be significantly higher. These patients often consume more healthcare resources and have poorer somatic health. In this study, we analyze potential differences in health, resources, and care process between stroke patients with and without a previous diagnosis of psychosis or schizophrenia.Methods: Ischemic stroke patients from seven regions in Sweden were identified via ICD-10 codes (I63.0-9) in regional administrative systems and the Swedish Stroke Register, and approximately 70% of all ischemic stroke cases in Sweden during 2008–2011 were included (n = 46,350). Relevant patient-level data from national registries were linked to enable multivariate regression analysis, including data on socioeconomics, mortality, municipality services, and filled prescriptions. History of psychosis or schizophrenia was defined via ICD-10 codes F20-29 (n = 389).Results: Patient-reported functional outcomes at 3 months and 1 year were significantly lower in the psychosis subgroup, and stroke recurrence was higher. Patients with pre-stroke psychosis did not receive the same levels of reperfusion treatment as the non-psychosis group. Time at the stroke unit was the same, as were first-year levels of somatic care, but dispensation of antihypertensives was less common.Conclusion: Our findings emphasize the importance of taking mental comorbidity into account during stroke treatment as well as when evaluating indicators for health, resources, and the care process, since mental comorbidity such as psychosis or schizophrenia may have a significant impact the year preceding and the year succeeding the stroke event.

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Long-Term Antipsychotic Use and Major Cardiovascular Events

Abstract: Older adult patients under antipsychotic regimens with high or intermediate risk of metabolic side effects may face a higher incidence of major cardiovascular events than those under a low-risk regimen during long-term follow-up.

Cited by 18 publications

References 0 publications

Intrinsic and Antipsychotic Drug-Induced Metabolic Dysfunction in Schizophrenia

Intrinsic and Antipsychotic Drug-Induced Metabolic Dysfunction in Schizophrenia

High risk of silent stroke in older bipolar patients with typical‐onset age

The Association of Pre-stroke Psychosis and Post-stroke Levels of Health, Resource Utilization, and Care Process: A Register-Based Study

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