title: The association between antipsychotic agents and the risk of myocardial infarction: a systematic review.
abstract: OBJECTIVE
  Patient populations that are prescribed antipsychotic agents have higher cardiovascular mortality rates. The risk of myocardial infarction is influenced by various factors that are more prevalent in patients with a mental illness. The aim of this review was to determine whether the use of antipsychotic agents is associated with the incidence of myocardial infarction in adults.
  
  
  METHODS
  Using multiple sources, all studies of antipsychotic agents using myocardial infarction as primary or secondary outcome measures were considered for inclusion. Study populations were adult subjects who had been prescribed an antipsychotic agent at least once in their medical history.
  
  
  RESULTS
  It total, five studies were identified. Four studies with small numbers of events reported a moderate to strong effect of typical antipsychotic agents on the risk of myocardial infarction. The largest study had a favourable internal validity compared with all other studies and reported no association between the risk of myocardial infarction and current use of either atypical (relative risk 0.98, 95% confidence interval [CI] 0.88, 1.09) or typical antipsychotic agents (relative risk 0.99, 95% CI 0.96, 1.03).
  
  
  CONCLUSIONS
  Clinical and methodological heterogeneity between the studies in this review led to an inconclusive answer to the question whether the use of antipsychotics is associated with the incidence of myocardial infarction in adults. Whilst results conflicted, the largest study did not find an association between the use of antipsychotic agents and an increased risk of myocardial infarction.
authors.affiliation: Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK. ruth.brauer@lshtm.ac.uk
authors.forename: Ruth
authors.initials: R
authors.lastname: Brauer
authors.forename: Ian
authors.initials: I
authors.lastname: Douglas
authors.forename: Liam
authors.initials: L
authors.lastname: Smeeth
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008019:Life Style; D001523:Mental Disorders / Q000150:complications / Q000188:drug therapy*; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents