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The association between antipsychotic agents and the risk of myocardial infarction: a systematic review
Ruth Brauer1, Ian Douglas, Liam Smeeth
1Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK. ruth.brauer@lshtm.ac.uk
Insights
This review examined antipsychotic agents and myocardial infarction risk. The largest study found no association between antipsychotic use and increased heart attack risk in adults.
Area of Science:
- Pharmacology
- Cardiology
- Psychiatry
Background:
- Patients on antipsychotic agents exhibit elevated cardiovascular mortality.
- Mental illness is linked to factors increasing myocardial infarction risk.
Purpose of the Study:
- To review the association between antipsychotic agent use and myocardial infarction incidence in adults.
Main Methods:
- Systematic review of studies on antipsychotic agents with myocardial infarction as an outcome.
- Inclusion of adult subjects prescribed antipsychotic agents.
Main Results:
- Four studies suggested a link between typical antipsychotics and myocardial infarction risk.
- The largest, most valid study found no association for atypical or typical antipsychotics (RR 0.98-0.99).
Conclusions:
- Heterogeneity in studies yielded inconclusive results on antipsychotics and myocardial infarction.
- The most robust study indicated no increased myocardial infarction risk with antipsychotic use.
Aim:
Patient populations that are prescribed antipsychotic agents have higher cardiovascular mortality rates. The risk of myocardial infarction is influenced by various factors that are more prevalent in patients with a mental illness. The aim of this review was to determine whether the use of antipsychotic agents is associated with the incidence of myocardial infarction in adults.
Methods:
Using multiple sources, all studies of antipsychotic agents using myocardial infarction as primary or secondary outcome measures were considered for inclusion. Study populations were adult subjects who had been prescribed an antipsychotic agent at least once in their medical history.
Results:
It total, five studies were identified. Four studies with small numbers of events reported a moderate to strong effect of typical antipsychotic agents on the risk of myocardial infarction. The largest study had a favourable internal validity compared with all other studies and reported no association between the risk of myocardial infarction and current use of either atypical (relative risk 0.98, 95% confidence interval [CI] 0.88, 1.09) or typical antipsychotic agents (relative risk 0.99, 95% CI 0.96, 1.03).
Conclusion:
Clinical and methodological heterogeneity between the studies in this review led to an inconclusive answer to the question whether the use of antipsychotics is associated with the incidence of myocardial infarction in adults. Whilst results conflicted, the largest study did not find an association between the use of antipsychotic agents and an increased risk of myocardial infarction.
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