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Cardiovascular Events Associated with Antipsychotics in Newly Diagnosed Parkinson's Disease Patients: A Propensity
1School of Pharmacy, King Khalid University, Abha, Saudi Arabia.
Insights
First-generation antipsychotics (FGAs) significantly increase ischemic heart disease (IHD) and mortality risk in Parkinson's disease (PD) patients. Caution is advised when prescribing antipsychotics for psychosis in this vulnerable population.
Area of Science:
- Neurology
- Cardiology
- Psychiatry
Background:
- Observational studies on antipsychotics and ischemic heart disease (IHD) often overlook comorbidities like Parkinson's disease (PD).
- Understanding the cardiovascular risks of antipsychotics in PD patients is crucial for safe treatment.
Purpose of the Study:
- To investigate the one-year risk of IHD, cardiovascular events, and all-cause mortality in newly diagnosed PD patients using antipsychotics compared to non-users.
- To assess the specific risks associated with first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) in PD patients.
Main Methods:
- A cohort of individuals aged 40+ with a new PD diagnosis was identified in the SAIL databank (2000-2016).
- Antipsychotic users were matched 1:1 with non-users using a propensity score model to control for confounding factors.
- Cox regression analysis was employed to determine hazard ratios (HR) and 95% confidence intervals (CIs) for study outcomes.
Main Results:
- First-generation antipsychotic (FGA) use was linked to a significantly higher risk of IHD (HR 2.60) and all-cause mortality (HR 7.56).
- Haloperidol, an FGA, showed the highest IHD risk (HR 3.01).
- Any antipsychotic use, including SGAs, was associated with increased all-cause mortality (HR 4.20), with SGAs also showing a significant risk (HR 3.28).
Conclusions:
- FGAs are associated with increased IHD and all-cause mortality risks in PD patients with psychosis.
- The findings highlight the need for cautious use of antipsychotics in PD patients experiencing psychosis.
- Further research may explore alternative treatments or risk mitigation strategies for this patient group.
Purpose:
Observational studies have examined the association between antipsychotics and ischemic heart disease (IHD) in general populations, but results did not take into account other comorbid diseases, such as Parkinson's disease (PD). This study investigates the one-year risk of IHD, all cardiovascular events, and all-cause mortality among newly diagnosed PD patients who used antipsychotics compared to non-users.
Materials And Methods:
This study included individuals aged 40 years or older with a first definitive PD diagnosis Read Code in the Secure Anonymised Information Linkage (SAIL) databank who had been initiated on any PD medication between 2000 and 2016. Antipsychotic users were matched 1:1 with non-users by a propensity score model to control the confounding effects of patients' demographics, social deprivation status, comorbidities, and medication history. Cox regression was performed to calculate the hazard ratios (HR) and 95% CIs for the association between antipsychotics and study outcomes.
Results:
A total of 1837 participants were included in the analysis. Users of first-generation antipsychotics (FGA) were significantly more likely to develop IHD compared to non-users, with an HR of 2.60 (95% CI 1.103-6.167). Among the FGAs, haloperidol had the highest likelihood of IHD developing, with an HR of 3.01 (95% CI 1.038-8.729). Any use of antipsychotics, regardless of whether they were FGA or second-generation antipsychotics (SGA), was linked to all-cause mortality, with an HR of 4.201 (95% CI 3.272-5.394). When subdividing antipsychotics into FGAs and SGAs, mortality was more likely in FGA users, with an HR of 7.557 (95% CI 5.633-10.139). Mortality also occurred in SGA users, but with a lower HR of 3.278 (95% CI 2.509-4.282).
Conclusion:
FGAs were associated with an increased risk of IHD and all-cause mortality in newly diagnosed PD patients with psychosis. This finding emphasizes the need to use antipsychotics with caution in PD patients with psychosis.
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