Risk of Mortality (Including Sudden Cardiac Death) and Major Cardiovascular Events in Atypical and Typical Antipsychotic Users: A Study with the General Practice Research Database

Abstract

Objective. Antipsychotics have been associated with increased cardiac events including mortality. This study assessed cardiac events including mortality among antipsychotic users relative to nonusers. Methods. The General Practice Research Database (GPRD) was used to identify antipsychotic users, matched general population controls, and psychiatric diseased nonusers. Outcomes included cardiac mortality, sudden cardiac death (SCD), all-cause mortality (excluding suicide), coronary heart disease (CHD), and ventricular arrhythmias (VA). Sensitivity analyses were conducted for age, dose, duration, antipsychotic type, and psychiatric disease. Results. 183,392 antipsychotic users (115,491 typical and 67,901 atypical), 544,726 general population controls, and 193,920 psychiatric nonusers were identified. Nonusers with schizophrenia, dementia, or bipolar disorder had increased risks of all-cause mortality compared to general population controls, while nonusers with major depression had comparable risks. Relative to psychiatric nonusers, the adjusted relative ratios (aRR) of all-cause mortality in antipsychotic users was 1.75 (95% CI: 1.64–1.87); cardiac mortality 1.72 (95% CI: 1.42–2.07); SCD primary definition 5.76 (95% CI: 2.90–11.45); SCD secondary definition 2.15 (95% CI: 1.64–2.81); CHD 1.16 (95% CI: 0.94–1.44); and VA 1.16 (95% CI: 1.02–1.31). aRRs of the various outcomes were lower for atypical versus typical antipsychotics (all-cause mortality 0.83 (95% CI: 0.80–0.85); cardiac mortality 0.89 (95% CI: 0.82–0.97); and SCD secondary definition 0.76 (95% CI: 0.55–1.04). Conclusions. Antipsychotic users had an increased risk of cardiac mortality, all-cause mortality, and SCD compared to a psychiatric nonuser cohort.

Antipsychotic Drugs and the Risk of Ventricular Arrhythmia and/or Sudden Cardiac Death: A Nation‐wide Case‐Crossover Study

“…Whereas we found that risk of VA/SCD among FGA users was higher than that among SGAs users, interestingly, the difference between FGA and SGA use was more obvious when we restricted our analysis to patients with a definitive diagnosis of VA. These findings are in line with previous epidemiological studies . However, the underlying mechanisms for the observed findings that show SGAs to be safer than FGAs have remained largely unclear.…”

“…Whether or not the risk of VA/SCD among SGA users is lower than that among FGA users remains inconclusive. Several studies have demonstrated that SGAs are associated with less torsadogenic risk than FGAs . However, such findings could not be consistently confirmed .…”

Coronary artery disease in adults with schizophrenia: Anatomy, treatment and outcomes

“…Recent data from Murray-Thomas and colleagues (2013) have demonstrated that the risk of arrhythmia and sudden cardiac death increased with antipsychotic dose and duration of anti-psychotic treatment [19]. The risk of arrhythmia (prolonged QT syndrome in particular) can become very high when other arrhythmogenic therapies are introduced, so diligence to prevent harmful drug interactions is needed for patients with severe mental illness treated with typical and atypical anti-psychotic medications.…”

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

“…Piśmiennictwo potwierdzające zalecenia nej [643]. Uważa się, że wynika to zarówno z tych chorób, jak i ich leczenia.…”