Atypical Antipsychotic Drugs and the Risk of Sudden Cardiac Death

Ray, Wayne A.; Chung, Cecilia P.; Murray, Katherine T.; Stein, C. Michael

doi:10.1056/nejmoa0806994

Cited by 1,052 publications

(771 citation statements)

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“…Los pacientes con EQZ tienen un riesgo aumentado de muerte súbita 24 , lo cual ha sido atribuido principalmente al uso de antipsicóticos 25 , comúnmente, a los efectos bloqueadores de la repolarización cardíaca, representado por el incremento del segmento electrocardiográfico QT 26,27 .…”

Section: Cardiovascularunclassified

Esquizofrenia y su asociación con enfermedades médicas crónicas

et al. 2017

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The life expectancy of patients with schizophrenia (SCH) is 11 to 20 years less than the general population. There is an association between SCH and various diseases and chronic conditions, highlighting the cardio-metabolic diseases. This association has been attributed to the use of antipsychoticsSe caracteriza por síntomas positivos (alucinaciones, delirio, síntomas catatónicos y discurso desorganizado), negativos (aplanamiento afectivo y anhedonia) y disfunciones cognitivas (alteración de atención, memoria y funciones ejecutivas) 1 . Además, hay perturbaciones fisiológicas severas que aumentan la gravedad de la EQZ, de hecho, se evidencian alteraciones endocrinológicas, del sueño, cardiovasculares y metabólicas con alteración del peso, regulación de glicemia, metabolismo lipídico y presión arterial, cuyos mecanismos no se conocen del todo 2 .La expectativa de vida de los pacientes con EQZ es entre 11 y 20 años menor que la población general y la mortalidad cardiovascular ha aumentado en este grupo de pacientes, en contraste a la población general 3 .El tratamiento antipsicótico siempre se ha asociado a estas alteraciones cardiometabólicas, sin embargo, la evidencia muestra que pacientes que nunca han recibido tratamiento también presentan estas patologías concomitantes 4 , además que muchas de ellas se encuentran desde el primer episodio psicótico, por ende, se postula que la EQZ per se estaría relacionada con esta alteración 5,6 .Este trabajo pretende actualizar los conocimientos con respecto a comorbilidades médicas crónicas asociadas a la EQZ y ayudar así a optimizar el manejo clínico de estos pacientes.

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Section: Cardiovascularunclassified

Esquizofrenia y su asociación con enfermedades médicas crónicas

et al. 2017

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“…However, the risk is not zero, thus caution is still indicated, perhaps especially for women and African Americans. In addition, recent concerns about increased cardiovascular and cerebrovascular morbidity and mortality associated with SGAs (Ray et al, 2009;Schneider et al, 2005;Wang et al, 2005) underscores the need for a cautious weighing of the benefits against the potential risks of antipsychotic use in older people.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Tardive Dyskinesia with Risperidone or Olanzapine in the Elderly: Results from a 2-Year, Prospective Study in Antipsychotic-Naïve Patients

Woerner

Correll

Alvir

et al. 2011

Neuropsychopharmacol

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Tardive dyskinesia (TD) rates with second-generation antipsychotics (SGAs) are considered to be low relative to first-generation antipsychotics (FGAs), even in the particularly vulnerable elderly population. However, risk estimates are unavailable for patients naïve to FGAs. Therefore, we aimed to determine the TD incidence in particularly vulnerable, antipsychotic-naïve elderly patients treated with the SGA risperidone or olanzapine. The present work describes a prospective inception cohort study of antipsychotic-naïve elderly patients aged X55 years identified at New York Metropolitan area in-patient and out-patient geriatric psychiatry facilities and nursing homes at the time of risperidone or olanzapine initiation. At baseline, 4 weeks, and at quarterly periods, patients underwent assessments of medical and medication history, abnormal involuntary movements, and extra-pyramidal signs. TD was classified using Schooler-Kane criteria. Included in the analyses were 207 subjects (age: 79.8 years, 70.0% female, 86.5% White), predominantly diagnosed with dementia (58.9%) or a major mood disorder (30.9%), although the principal treatment target was psychosis (78.7%), with (59.4%) or without (19.3%) agitation. With risperidone (n ¼ 159) the cumulative TD rate was 5.3% (95% confidence interval (CI): 0.7, 9.9%) after 1 year (mean dose: 1.0±0.76 mg/day) and 7.2% (CI: 1.4, 12.9%) after 2 years. With olanzapine (n ¼ 48) the cumulative TD rate was 6.7% (CI: 0, 15.6%) after 1 year (mean dose: 4.3±1.9 mg/day) and 11.1% (CI: 0, 23.1%) after 2 years. TD risk was higher in females, African Americans, and patients without past antidepressant treatment or with FGA co-treatment. The TD rates for geriatric patients treated with risperidone and olanzapine were comparable and substantially lower than previously reported for similar patients in direct observation studies using FGAs. This information is relevant for all patients receiving antipsychotics, not just the especially sensitive elderly.

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“…The heightened incidence of CVD among persons with SMI not only raises the risk of death but also portends costly health care services in both in-and out-patient settings. An increasing body of research has begun to identify pathways that connect SMI to CVD morbidity (Newcomer & Hennekens, 2007;Ray, Chung, Murray, Hall, & Stein, 2009). Here we build on this research base and test the hypothesis that, among persons with SMI, co-occurring substance use disorder (SUD) increases the risk of CVD death.…”

Section: Introductionmentioning

confidence: 99%

“…Next, we control for other comorbidities at baseline that may increase CVD mortality. We also control for the independent risk among the SMI population of atypical antipsychotics increasing sudden 7 cardiac death (Ray, Chung, Murray, Hall, & Stein, 2009;Newcomer & Haupt, 2006). We included a Charlson co-morbidity score (range: 1-29), recommended in the literature, which captures illness severity and predicts premature death (Sundararajan et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular Disease Mortality of Medicaid Clients with Severe Mental Illness and a Co-occurring Substance Use Disorder

Bruckner

Yoon

Gonzales

2016

Adm Policy Ment Health

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Increasing attention focuses on cardiovascular disease (CVD) among persons with SMI. We examined, among persons with SMI, whether co-occurring substance use disorder (SUD) elevates the risk of CVD death. We linked 2002 to 2007 Medicaid claims data on 121,817 persons with SMI to cause and date of death information. We applied a proportional hazards model that controls for co-morbidity at baseline, atypical antipsychotic prescription medications, age, gender and race/ethnicity. Results among persons with co-occurring SUD indicate a 24% increased risk of CVD death (Hazard Ratio = 1.24; 95% Confidence Interval=1.17 -1.33). We encourage further coordination of services for this population.

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Atypical Antipsychotic Drugs and the Risk of Sudden Cardiac Death

Abstract: Background-Users of typical antipsychotics have increased risk of serious ventricular arrhythmias and sudden cardiac death. However, less is known regarding the cardiac safety of the atypical antipsychotic drugs, which have largely replaced the older agents in clinical practice.

Cited by 1,052 publications

References 57 publications

Esquizofrenia y su asociación con enfermedades médicas crónicas

Esquizofrenia y su asociación con enfermedades médicas crónicas

Incidence of Tardive Dyskinesia with Risperidone or Olanzapine in the Elderly: Results from a 2-Year, Prospective Study in Antipsychotic-Naïve Patients

Cardiovascular Disease Mortality of Medicaid Clients with Severe Mental Illness and a Co-occurring Substance Use Disorder

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