Use of antipsychotics and risk of myocardial infarction: a systematic review and meta‐analysis

Abstract

AIMThere is emerging concern that antipsychotics may be associated with an increased risk of myocardial infarction (MI). A previous review identified five observational studies that did not provide an accurate estimate of the association between antipsychotic drug use and MI risk. More recent studies have produced variable results. METHODSWe performed a systematic review and meta-analysis of observational studies to determine whether antipsychotic use affects the risk for MI. Our analysis included all observational studies that compared MI incidence among patients receiving antipsychotics vs. no treatment. RESULTSNine observational studies were included in the analysis. The odds for developing MI were 1.88-fold higher (odds ratio (OR) 1.88, 95% confidence interval (CI) 1.39, 2.54) in antipsychotic users compared with individuals who had not taken antipsychotics. Subgroup analyses found an OR of 2.48 (95% CI 1.66, 3.69) among patients with schizophrenia and an OR of 2.64 (95% CI 2.48, 2.81) among short term (<30 days) antipsychotic users. CONCLUSIONThe findings of this meta-analysis support an increased risk of MI in antipsychotic drug users. The present systematic review expands previous knowledge by demonstrating an increased and more pronounced risk in short term users.

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

“…Another meta-analysis found a 1.88-fold higher likelihood [odds ratio (OR) = 1.88, 95% CIs: 1.39-2.54) of MI in AP users vs. non-users (Yu et al, 2016). More pronounced MI risk (OR 2.64, 95% CIs 2.48-2.81) was found in short-term users.…”

Antipsychotic drug exposure and risk of myocardial infarction

“…Risk was substantially increased in short-term users, thus suggesting an acute effect of AP drugs, although it remains unclear if AP dose (which could have been higher during short-term acute treatment) or acute medical conditions may have had a role in this finding (Yu et al 2016).…”

“…Two studies found that AP drug use was associated with a dose-dependent increase in MI risk, but one study did not. On the basis of methodological quality assessment (based on the Newcastle-Ottawa Scale), six studies were of high quality and three were of low quality (Yu et al 2016).The review authors concluded that, although AP use was associated with a modestly increased risk of MI, the population impact of such a modest risk is likely to be substantial because of the large number of AP users globally. Risk was substantially increased in short-term users, thus suggesting an acute effect of AP drugs, although it remains unclear if AP dose (which could have been higher during short-term acute treatment) or acute medical conditions may have had a role in this finding (Yu et al 2016).…”

“…On the basis of methodological quality assessment (based on the Newcastle-Ottawa Scale), six studies were of high quality and three were of low quality (Yu et al 2016).…”

“…A practical example of synthesis of observational studies for investigating the occurrence of a safety outcome has recently been provided by Yu et al (2016), who carried out a systematic review investigating whether exposure to antipsychotic drugs (AP) increases the risk of myocardial infarction (MI). This association has been investigated by several epidemiological studies, but findings are controversial and therefore difficult to translate into practical recommendations.…”