Myocardial infarction risk and antipsychotics use revisited: a meta-analysis of 10 observational studies

Abstract

Objective: Associations between antipsychotic agent (AP) use and myocardial infarction (MI) risk have been inconsistent and remain controversial. We therefore conducted a meta-analysis of observational studies to address this knowledge gap.Method: Detailed electronic database searches were performed to identify reports of observational studies that evaluated the association between AP use and the risk of MI.Pooled odds ratios were calculated using random or fixed-effects models. Results:In total, 4 case-control studies, 2 case-crossover studies, 1 case-case time control study, 3 cohort studies, and 1 self-controlled case serieswere included. The pooled odds ratio (95% CIs) between any AP use and MI risk was 1.55 (1.33-1.79) compared with non-use: 1.39 (1.06-1.82) for atypical AP use and 1.57 (1.29-1.91) for typical AP use. Subgroup analyses indicated that male gender, schizophrenia diagnosis and AP exposure periods ≦60 days, but not prior cardiovascular disease diagnosisor older age, were associated with higher risk of MI. Conclusion:Current evidence, based on 10 observational studies, suggested that AP use might be a potential risk factor of MI. However, we cannot conclude at this time due to significant heterogeneity among studies. We suggest that, instead of not using APs in fear of the risk, careful cardiovascular monitoring before and during AP treatment in high-risk patients group is needed. Additional high-quality prospective studies are required to evaluate the association between APs and the risk of MI.

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

“…To the best of our knowledge, this is the largest study on the sex difference of the association between antipsychotics and IHD incidence in a primary care population. Our results are consistent with a previous study of 277,817 adults which showed a more substantial elevation of the risk of IHD among women with various psychiatric disorders treated with antipsychotics compared with men [ 16 ], but are inconsistent with a meta-analysis which showed that the association was slightly stronger among men than among women in a pooled analysis [ 5 ]. This inconsistent finding may have been due to the different patient populations adopted by the included studies.…”

“…This inconsistent finding may have been due to the different patient populations adopted by the included studies. In fact, most reviewed studies only included patients with certain psychiatric disorders, such as schizophrenia, unlike our current study which observed a much more diverse population of primary care patients [ 5 ].…”

“…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 ]. For instance, in a review of 399,868 participants from nine observational studies [ 2 ], antipsychotic medications were found to be associated with 121%-elevated odds of myocardial infarction, whereas in another meta-analysis [ 3 ], no significant association was observed.…”

Child maltreatment, psychopathological symptoms, and onset of diabetes mellitus, hypothyroidism and COPD in adulthood

“…The mediation model (i.e., CMmental healthphysical health) has convincing support from previous longitudinal studies and could be most plausible for physical health outcomes that are "stress-related" such as COPD. Indeed, previous evidence suggests that poor mental health is associated (directly or indirectly via medication) with an increased risk of a wide range of physical health outcomes (Blanchette et al, 2008;Cohen et al, 2000;Correll et al, 2015;Correll et al, 2017;Coupland et al, 2011;Hippisley-Cox et al, 2001;Huang et al, 2017;Mock and Arai, 2011;Pan et al, 2010;Rubin et al, 2008;Scott et al, 2011;Tata et al, 2005;Vancampfort et al, 2015;Yoon et al, 2013). For instance, use of tricyclic tranquilizers can cause metabolic syndrome (Van Reedt Dortland et al, 2010).…”

Comparative risk of harm associated with trazodone or atypical antipsychotic use in older adults with dementia: a retrospective cohort study

“…Although both trazodone and atypical antipsychotics have been associated with an increased risk of falls and fractures, anti psychotic use has also been associated with an increased risk of myocardial infarction and stroke in patients with dementia. 12,50,80…”