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Cardiovascular and metabolic risk of antipsychotics in children and young adults: a multinational self-controlled

Kenneth K C Man1,2,3, Shih-Chieh Shao4,5, Yu-Chuan Chang4

  • 1Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.

Epidemiology and Psychiatric Sciences
|November 9, 2021
PubMed

Insights

Long-term antipsychotic use in young people increases metabolic risks but not cardiovascular risks. This study analyzed data from over 48,000 individuals across four countries, highlighting the importance of monitoring metabolic health during extended antipsychotic treatment.

Area of Science:

  • Pharmacovigilance
  • Pediatric Pharmacology
  • Cardiovascular Epidemiology

Background:

  • Antipsychotic medications are widely used in children and young adults.
  • Limited real-world data exists on the comparative risks of cardiovascular and metabolic events associated with antipsychotic use in this population across different countries.
  • Understanding these risks is crucial for optimizing treatment strategies and patient safety.

Purpose of the Study:

  • To evaluate the risks of cardiovascular and metabolic events in children and young adults receiving antipsychotic treatment.
  • To compare these risks across different exposure durations and geographical regions.

Main Methods:

  • A multinational self-controlled case series (SCCS) study was conducted using nationwide databases from Taiwan, Korea, Hong Kong, and the UK.
  • The study included approximately 100 million individuals, focusing on patients aged 6-30 years exposed to antipsychotics.
  • Cardiovascular events (stroke, ischemic heart disease, myocardial infarction) and metabolic events (hypertension, type 2 diabetes, dyslipidemia) were analyzed across various antipsychotic exposure windows.

Main Results:

  • The analysis included 48,515 individuals.
  • A statistically significant increased risk of metabolic events was observed only with long-term exposure (more than 90 days), with a pooled incidence rate ratio (IRR) of 1.29 (95% CI 1.20-1.38).
  • No significant association was found between antipsychotic exposure and cardiovascular events across any exposure window.

Conclusions:

  • Long-term exposure to antipsychotics is associated with an increased risk of metabolic events in children and young adults.
  • Antipsychotic use in this age group did not appear to trigger cardiovascular events.
  • These findings underscore the need for vigilant metabolic monitoring in pediatric and young adult patients on extended antipsychotic therapy.
Abstract

Keywords:
Antipsychoticscardiovascular eventschildren and young adultsmetabolic syndromemulti-national studyself-controlled case series

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