title: Long-Term Antipsychotic Use and Major Cardiovascular Events: A Retrospective Cohort Study.
abstract: OBJECTIVE
  Chronic treatment with antipsychotics may result in both metabolic side effects and cardiovascular disease. Our aim was to evaluate the effect of antipsychotic medications categorized by their metabolic side effect profiles as low, intermediate, or high risk on major cardiovascular events.
  
  
  METHODS
  A retrospective cohort study was conducted in adult outpatients aged 30 years or older initiating antipsychotic treatment from 2002 to 2007. Antipsychotic medications were divided into 3 groups (low-, intermediate-, and high-risk) according to the severity of their side-effect profiles in developing metabolic abnormalities associated with cardiovascular disease. The primary outcome measure was the time to the composite of acute myocardial infarction, acute coronary syndrome, ischemic stroke, peripheral artery disease, or a new revascularization procedure. Inverse probability weighting of a marginal structural Cox model was used to adjust for confounding.
  
  
  RESULTS
  A total of 1,008 patients were included (mean age = 72.4 years, median follow-up = 36.5 months), and 19.6% of patients experienced the primary outcome. The adjusted hazard ratios of a major cardiovascular event for patients in the high- or intermediate-risk medication groups compared to the low-risk group were 2.82 (95% CI, 1.57-5.05) and 2.57 (95% CI, 1.43-4.63), respectively.
  
  
  CONCLUSIONS
  Older adult patients under antipsychotic regimens with high or intermediate risk of metabolic side effects may face a higher incidence of major cardiovascular events than those under a low-risk regimen during long-term follow-up.
authors.affiliation: Hospital de Emergencias Psiquiátricas Torcuato de Alvear, Pharmacology Department, School of Medicine, University of Buenos Aires, Paraguay 2155, Ciudad Autónoma de Buenos Aires, Argentina, C1121. alejandroszm@gmail.com.|Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina.|Hospital de Emergencias Psiquiátricas Torcuato de Alvear, Buenos Aires, Argentina.|Department of Pharmacology, University of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Alejandro G
authors.initials: AG
authors.lastname: Szmulewicz
authors.affiliation: Department of Pharmacology, University of Buenos Aires, Buenos Aires, Argentina.|Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Federico
authors.initials: F
authors.lastname: Angriman
authors.affiliation: Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.|New York Presbyterian Hospital, Columbia University Medical Center, Department of General Surgery, New York, New York, USA.
authors.forename: Felipe E
authors.initials: FE
authors.lastname: Pedroso
authors.affiliation: Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.|Pharmacology Section, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Carolina
authors.initials: C
authors.lastname: Vazquez
authors.affiliation: Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina.|National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
authors.forename: Diego J
authors.initials: DJ
authors.lastname: Martino
mesh_terms: D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D001118:Argentina / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D015994:Incidence; D000069451:Long Term Adverse Effects / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000453:epidemiology; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations