title: Antipsychotic use and myocardial infarction in older patients with treated dementia.
abstract: BACKGROUND
  Antipsychotic agents (APs) are commonly prescribed to older patients with dementia. Antipsychotic use is associated with an increased risk of ischemic stroke in this population. Our study aimed to investigate the association of AP use with the risk of acute myocardial infarction (MI).
  
  
  METHODS
  A retrospective cohort of community-dwelling older patients who initiated cholinesterase inhibitor treatment was identified between January 1, 2000, and December 31, 2009, using the Quebec, Canada, prescription claims database. From this source cohort, all new AP users during the study period were matched with a random sample of AP nonusers. The risk of MI was evaluated using Cox proportional hazards models, adjusting for age, sex, cardiovascular risk factors, psychotropic drug use, and propensity scores. In addition, a self-controlled case series study using conditional Poisson regression modeling was conducted.
  
  
  RESULTS
  Among the source cohort of 37,138 cholinesterase inhibitor users, 10,969 (29.5%) initiated AP treatment. Within 1 year of initiating AP treatment, 1.3% of them had an incident MI. Hazard ratios for the risk of MI after initiation of AP treatment were 2.19 (95% CI, 1.11-4.32) for the first 30 days, 1.62 (95% CI, 0.99-2.65) for the first 60 days, 1.36 (95% CI, 0.89-2.08) for the first 90 days, and 1.15 (95% CI, 0.89-1.47) for the first 365 days. The self-controlled case series study conducted among 804 incident cases of MI among new AP users yielded incidence rate ratios of 1.78 (95% CI, 1.26-2.52) for the 1- to 30-day period, 1.67 (95% CI, 1.09-2.56) for the 31- to 60-day period, and 1.37 (95% CI, 0.82-2.28) for the 61- to 90-day period.
  
  
  CONCLUSIONS
  Antipsychotic use is associated with a modest and time-limited increase in the risk of MI among community-dwelling older patients treated with cholinesterase inhibitors.
authors.affiliation: Faculty of Pharmacy, Université de Montréal, Succursale Centre-ville, QC, Canada.
authors.forename: Antoine
authors.initials: A
authors.lastname: Pariente
authors.forename: Annie
authors.initials: A
authors.lastname: Fourrier-Réglat
authors.forename: Thierry
authors.initials: T
authors.lastname: Ducruet
authors.forename: Paddy
authors.initials: P
authors.lastname: Farrington
authors.forename: Sarah-Gabrielle
authors.initials: SG
authors.lastname: Béland
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dartigues
authors.forename: Nicholas
authors.initials: N
authors.lastname: Moore
authors.forename: Yola
authors.initials: Y
authors.lastname: Moride
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D003704:Dementia / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000453:epidemiology*; D016012:Poisson Distribution; D016016:Proportional Hazards Models; D011792:Quebec / Q000453:epidemiology; D012111:Residence Characteristics; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors