title: Antipsychotic drugs and risks of myocardial infarction: a self-controlled case series study.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Ruth
authors.initials: R
authors.lastname: Brauer
authors.affiliation: 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.
authors.forename: Liam
authors.initials: L
authors.lastname: Smeeth
authors.affiliation: Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: Karim
authors.initials: K
authors.lastname: Anaya-Izquierdo
authors.affiliation: National Institute for Health Research Biomedical Research Unit, Barts Health, London, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Timmis
authors.affiliation: Department of Epidemiology and Public Health, Clinical Epidemiology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
authors.forename: Spiros C
authors.initials: SC
authors.lastname: Denaxas
authors.affiliation: Department of Statistics, The Open University, Milton Keynes MK7 6BJ, UK.
authors.forename: C Paddy
authors.initials: CP
authors.lastname: Farrington
authors.affiliation: Department of Statistics, The Open University, Milton Keynes MK7 6BJ, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Whitaker
authors.affiliation: Department of Epidemiology and Public Health, Clinical Epidemiology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
authors.forename: Harry
authors.initials: H
authors.lastname: Hemingway
authors.affiliation: 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.
authors.forename: Ian
authors.initials: I
authors.lastname: Douglas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced*; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotic agents; Case–control study; Myocardial infarction; Self-controlled case series