Antipsychotic drugs may increase risk for major cardiac events

  • Zivkovic S & al.
  • BMC Psychiatry
  • 20 Jun 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • This meta-analysis suggests that antipsychotic (AP) drugs may be associated with risk for stroke, but there is no clear evidence of an association with increased risk for myocardial infarction (MI).
  • The risk was less apparent among patients with dementia.

Why this matters

  • There is no clarity on the associations between AP drug use and the occurrence of major cardio- and cerebrovascular events.

Study design

  • Meta-analysis of 29 observational studies (19 on stroke and 10 on MI) evaluating the association between AP drug use and the risk for stroke or MI.
  • Funding: None disclosed.

Key results

  • Among studies including a general population, the risk for stroke was 2.3-fold higher with use of any AP drug, but with substantial heterogeneity (pooled HR, 2.31; 95% CI, 1.14-4.74; I2=83.2%).
  • In patients with dementia, the association between the use of any AP drug and risk for stroke was marginally significant (pooled HR, 1.16; 95% CI, 1.00-1.33; I2=0%).
  • Studies including only psychiatric patients demonstrated a statistically non-significant increased risk for stroke (pooled HR, 1.44; 95% CI, 0.90-2.30; I2=78.8%).
  • No association observed between AP drug use and MI risk (pooled HR for cohort studies: 1.29; 95% CI, 0.88-1.90; P=.05, I2=62.6% and case-control studies: 1.07; 95% CI, 0.94-1.23; P=.003, I2=78.3%).

Limitations

  • Heterogeneity among included studies.
  • Confounding by indication.