Association Between Antipsychotic Use and Risk of Acute Myocardial Infarction

Abstract

R ecent evidence suggests that psychiatric patients may be at increased risk for cardiovascular events. Large community studies report that people with mental illnesses have a 2-to 5-fold greater risk of coronary heart disease and a 2-to 3-fold greater risk of cardiac mortality than the general population. [1][2][3] This increased risk might be explained by risk factors commonly noted in these patients, including smoking, obesity, and unhealthy lifestyles. 4-6 Clinical Perspective on p 243The association of risk for acute myocardial infarction (AMI) with antipsychotic treatment remains unclear because earlier analyses have methodological issues (eg, residual confounding and limited statistical power and external validity). 3,[7][8][9][10][11] If the link exists, more attention might be paid to monitoring drug safety, especially because of current increased use of antipsychotics and the widening range of disorders for which they are being indicated. 12This study tapped a large nationwide population-based data set to investigate the association between antipsychotic treatment and risk of AMI in patients with mental disorders. A casecrossover design was used to eliminate known or unknown within-subject time-invariant confounders while examining the acute effects of various antipsychotics on subsequent AMI Background-Antipsychotic medications have been increasingly and more widely prescribed despite continued uncertainty about their association with the incidence of acute myocardial infarction (AMI

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

“…Our findings of elevated risk for MI in short term APs users are also consistent with those from previous studies (Brauer et al, 2015;Lin et al, 2014;Pariente et al, 2012;Yu et al, 2016), where the incidence rate of MI has been found to be higher during the first two months of treatment, declining with longer exposure time and potentially related to AP tolerance and cross-tolerance (Lin et al, 2014;Yu et al, 2016). Another explanation for such possibility might be that the indication for which APs were prescribed (e.g., acute psychotic phase in schizophrenia) was associated with state dependent cardiovascular risk factors (e.g., agitation), which then being controlled (e.g., because of AP treatment) in later months.…”

“…(Lin et al, 2014), finding the highest risk with amisulpiride (OR 5.65, 95% CIs 2.97-10.76). However, another study conducted by Sahlberg et al (2015) found that the incidence of major adverse cardiovascular events (comprised the first occurring nonfatal MI) was higher with use of levomepromazine (RR 3.80, 95% CIs to typical and atypical APs as previously reported (Huybrechts et al, 2012;Jackson et al, 2015;Wang et al, 2009), differences between typical and atypical agents were observed in one direct comparison (Vasilyeva et al, 2013) which found higher MI risk in people using atypical APs.…”

Religious Beliefs and Their Relevance for Treatment Adherence in Mental Illness: A Review

“…In the study which analyzed blood level of the drug, an inverse relationship was found between religiosity and medication compliance (Borras et al 2007). Studies of patients with addictions, including between 357 and 1,726 subjects, were the largest sources of evidence for this review (Kelly et al 2011;Krentzman et al 2013;Lin et al 2014). These studies were based on a 12-step program for recovery from addiction, including spiritual elements; participation in this form of intervention apparently stimulated involvement of patients in religious activities.…”

Effects of prolonged antipsychotic administration on neuregulin-1/ErbB signaling in rat prefrontal cortex and myocardium: implications for the therapeutic action and cardiac adverse effect

“…However, the use of either typical or atypical antipsychotic drugs is also a major risk factor (Fan et al, 2013). Although it has been well-documented that antipsychotics-induced metabolic side-effects, such as diabetes, obesity and dyslipidemia, can indirectly bring additional burden on cardiovascular system, there is substantial evidence that the drug use can also directly cause cardiotoxicity, including arrhythmia, myocarditis and cardiomyopathy (Citrome et al, 2013;Lin et al, 2014;Stroup et al, 2013). Despite the increased concern over antipsychoticinduced cardiovascular mortality, the underlying mechanism of action of antipsychotics on cardiovascular system remains poorly understood.…”