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Eur Heart J. 2015 Apr 21;36(16):984-92. doi: 10.1093/eurheartj/ehu263. Epub 2014 Jul 8.

Antipsychotic drugs and risks of myocardial infarction: a self-controlled case series study.

Author information

1
Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK ruth.brauer@lshtm.ac.uk.
2
Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
3
Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
4
National Institute for Health Research Biomedical Research Unit, Barts Health, London, UK.
5
Department of Epidemiology and Public Health, Clinical Epidemiology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
6
Department of Statistics, The Open University, Milton Keynes MK7 6BJ, UK.

Abstract

AIM:

Antipsychotics increase the risk of stroke. Their effect on myocardial infarction remains uncertain because people prescribed and not prescribed antipsychotic drugs differ in their underlying vascular risk making between-person comparisons difficult to interpret. The aim of our study was to investigate this association using the self-controlled case series design that eliminates between-person confounding effects.

METHODS AND RESULTS:

All the patients with a first recorded myocardial infarction and prescription for an antipsychotic identified in the Clinical Practice Research Datalink linked to the Myocardial Ischaemia National Audit Project were selected for the self-controlled case series. The incidence ratio of myocardial infarction during risk periods following the initiation of antipsychotic use relative to unexposed periods was estimated within individuals. A classical case-control study was undertaken for comparative purposes comparing antipsychotic exposure among cases and matched controls. We identified 1546 exposed cases for the self-controlled case series and found evidence of an association during the first 30 days after the first prescription of an antipsychotic, for first-generation agents [incidence rate ratio (IRR) 2.82, 95% confidence interval (CI) 2.0-3.99] and second-generation agents (IRR: 2.5, 95% CI: 1.18-5.32). Similar results were found for the case-control study for new users of first- (OR: 3.19, 95% CI: 1.9-5.37) and second-generation agents (OR: 2.55, 95% CI: 0.93-7.01) within 30 days of their myocardial infarction.

CONCLUSION:

We found an increased risk of myocardial infarction in the period following the initiation of antipsychotics that was not attributable to differences between people prescribed and not prescribed antipsychotics.

KEYWORDS:

Antipsychotic agents; Case–control study; Myocardial infarction; Self-controlled case series

PMID:
25005706
PMCID:
PMC4404491
DOI:
10.1093/eurheartj/ehu263
[Indexed for MEDLINE]
Free PMC Article

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