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.
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.
Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London SWIW 9SZ, UK.
Tarita
T
Murray-Thomas
Eli Lilly and Company, Indianapolis, IN, USA.
Meghan E
ME
Jones
Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London SWIW 9SZ, UK.
Deven
D
Patel
Eli Lilly and Company, Indianapolis, IN, USA.
Elizabeth
E
Brunner
Eli Lilly and Company, Indianapolis, IN, USA.
Chetan C
CC
Shatapathy
Eli Lilly and Company, Indianapolis, IN, USA.
Stephen
S
Motsko
Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London SWIW 9SZ, UK ; London School of Hygiene & Tropical Medicine, London, UK ; Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
Tjeerd P
TP
Van Staa