title: Antipsychotic exposure prior to acute myocardial infarction in patients with serious mental illness.
abstract: OBJECTIVE
  To investigate the association between acute myocardial infarction (AMI) and recent exposure to antipsychotic agents in people with serious mental illness (SMI), and modifying influences.
  
  
  METHODS
  A case-crossover design was applied using the Taiwan National Health Insurance Research Database (NHIRD) to compare the exposure frequency of antipsychotic agents within individuals of schizophrenia or bipolar disorder between 60-day case and control periods prior to their first AMI episode during 1996-2007.
  
  
  RESULTS
  A sample of 834 patients with incident AMI was analysed. AMI was significantly associated with more recent antipsychotic exposure in schizophrenia after adjustment (OR 1.87, 95% confidence interval 1.15-3.03) bipolar disorder (OR 1.06, 0.51-2.21). This association in schizophrenia was significantly stronger in men and in patients without previous diagnoses of cardiovascular risk factors.
  
  
  CONCLUSIONS
  These findings are consistent with a short-term risk effect of antipsychotic exposure on risk of AMI and identify potentially vulnerable groups. Further research is required to clarify underlying biological mechanisms.
authors.affiliation: Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Audiology and Speech Language Pathology, Mackay Medical College, Taipei, Taiwan.
authors.forename: S-I
authors.initials: SI
authors.lastname: Wu
authors.forename: K-L
authors.initials: KL
authors.lastname: Kao
authors.forename: S-C
authors.initials: SC
authors.lastname: Chen
authors.forename: J J M
authors.initials: JJ
authors.lastname: Juang
authors.forename: C-J
authors.initials: CJ
authors.lastname: Lin
authors.forename: C-K
authors.initials: CK
authors.lastname: Fang
authors.forename: C-S
authors.initials: CS
authors.lastname: Wu
authors.forename: M
authors.initials: M
authors.lastname: Dewey
authors.forename: M J
authors.initials: MJ
authors.lastname: Prince
authors.forename: R
authors.initials: R
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D016022:Case-Control Studies; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000453:epidemiology*; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology*; D013624:Taiwan / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents
keywords: acute myocardial infarction; antipsychotic; bipolar disorder; schizophrenia; serious mental illness