Antipsychotic drugs and risks of myocardial infarction

A self-controlled case series study

Ruth Brauer, Liam Smeeth, Karim Anaya-Izquierdo, Adam Timmis, Spiros C Denaxas, C Paddy Farrington, Heather Whitaker, Harry Hemingway, Ian Douglas

Research output: Contribution to journalArticle

20 Citations (Scopus)
39 Downloads (Pure)

Abstract

Aim
Antipsychotics increase the risk of stroke. Their effect on myocardial infarction remains uncertain because people prescribed and not prescribed antipsychotic drugs differ in their underlying vascular risk making between-person comparisons difficult to interpret. The aim of our study was to investigate this association using the self-controlled case series design that eliminates between-person confounding effects.

Methods and results
All the patients with a first recorded myocardial infarction and prescription for an antipsychotic identified in the Clinical Practice Research Datalink linked to the Myocardial Ischaemia National Audit Project were selected for the self-controlled case series. The incidence ratio of myocardial infarction during risk periods following the initiation of antipsychotic use relative to unexposed periods was estimated within individuals. A classical case–control study was undertaken for comparative purposes comparing antipsychotic exposure among cases and matched controls. We identified 1546 exposed cases for the self-controlled case series and found evidence of an association during the first 30 days after the first prescription of an antipsychotic, for first-generation agents [incidence rate ratio (IRR) 2.82, 95% confidence interval (CI) 2.0–3.99] and second-generation agents (IRR: 2.5, 95% CI: 1.18–5.32). Similar results were found for the case–control study for new users of first- (OR: 3.19, 95% CI: 1.9–5.37) and second-generation agents (OR: 2.55, 95% CI: 0.93–7.01) within 30 days of their myocardial infarction.

Conclusion
We found an increased risk of myocardial infarction in the period following the initiation of antipsychotics that was not attributable to differences between people prescribed and not prescribed antipsychotics.
Original languageEnglish
Pages (from-to)984–992
Number of pages9
JournalEuropean Heart Journal
Volume36
Issue number16
Early online date8 Jul 2014
DOIs
Publication statusPublished - 21 Apr 2015

Fingerprint

Antipsychotic Agents
Myocardial Infarction
Blood Vessels
Stroke

Keywords

  • myocardial infarction
  • Antipsychotic agents
  • Self-controlled case series
  • Case-control study

Cite this

Brauer, R., Smeeth, L., Anaya-Izquierdo, K., Timmis, A., Denaxas, S. C., Farrington, C. P., ... Douglas, I. (2015). Antipsychotic drugs and risks of myocardial infarction: A self-controlled case series study. European Heart Journal, 36(16), 984–992. https://doi.org/10.1093/eurheartj/ehu263

Antipsychotic drugs and risks of myocardial infarction : A self-controlled case series study. / Brauer, Ruth; Smeeth, Liam; Anaya-Izquierdo, Karim; Timmis, Adam; Denaxas, Spiros C; Farrington, C Paddy; Whitaker, Heather; Hemingway, Harry; Douglas, Ian.

In: European Heart Journal, Vol. 36, No. 16, 21.04.2015, p. 984–992.

Research output: Contribution to journalArticle

Brauer, R, Smeeth, L, Anaya-Izquierdo, K, Timmis, A, Denaxas, SC, Farrington, CP, Whitaker, H, Hemingway, H & Douglas, I 2015, 'Antipsychotic drugs and risks of myocardial infarction: A self-controlled case series study', European Heart Journal, vol. 36, no. 16, pp. 984–992. https://doi.org/10.1093/eurheartj/ehu263
Brauer, Ruth ; Smeeth, Liam ; Anaya-Izquierdo, Karim ; Timmis, Adam ; Denaxas, Spiros C ; Farrington, C Paddy ; Whitaker, Heather ; Hemingway, Harry ; Douglas, Ian. / Antipsychotic drugs and risks of myocardial infarction : A self-controlled case series study. In: European Heart Journal. 2015 ; Vol. 36, No. 16. pp. 984–992.
@article{fc2e1bad175340e49df097946a335a73,
title = "Antipsychotic drugs and risks of myocardial infarction: A self-controlled case series study",
abstract = "AimAntipsychotics increase the risk of stroke. Their effect on myocardial infarction remains uncertain because people prescribed and not prescribed antipsychotic drugs differ in their underlying vascular risk making between-person comparisons difficult to interpret. The aim of our study was to investigate this association using the self-controlled case series design that eliminates between-person confounding effects.Methods and resultsAll the patients with a first recorded myocardial infarction and prescription for an antipsychotic identified in the Clinical Practice Research Datalink linked to the Myocardial Ischaemia National Audit Project were selected for the self-controlled case series. The incidence ratio of myocardial infarction during risk periods following the initiation of antipsychotic use relative to unexposed periods was estimated within individuals. A classical case–control study was undertaken for comparative purposes comparing antipsychotic exposure among cases and matched controls. We identified 1546 exposed cases for the self-controlled case series and found evidence of an association during the first 30 days after the first prescription of an antipsychotic, for first-generation agents [incidence rate ratio (IRR) 2.82, 95{\%} confidence interval (CI) 2.0–3.99] and second-generation agents (IRR: 2.5, 95{\%} CI: 1.18–5.32). Similar results were found for the case–control study for new users of first- (OR: 3.19, 95{\%} CI: 1.9–5.37) and second-generation agents (OR: 2.55, 95{\%} CI: 0.93–7.01) within 30 days of their myocardial infarction.ConclusionWe found an increased risk of myocardial infarction in the period following the initiation of antipsychotics that was not attributable to differences between people prescribed and not prescribed antipsychotics.",
keywords = "myocardial infarction, Antipsychotic agents, Self-controlled case series, Case-control study",
author = "Ruth Brauer and Liam Smeeth and Karim Anaya-Izquierdo and Adam Timmis and Denaxas, {Spiros C} and Farrington, {C Paddy} and Heather Whitaker and Harry Hemingway and Ian Douglas",
year = "2015",
month = "4",
day = "21",
doi = "10.1093/eurheartj/ehu263",
language = "English",
volume = "36",
pages = "984–992",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "16",

}

TY - JOUR

T1 - Antipsychotic drugs and risks of myocardial infarction

T2 - A self-controlled case series study

AU - Brauer, Ruth

AU - Smeeth, Liam

AU - Anaya-Izquierdo, Karim

AU - Timmis, Adam

AU - Denaxas, Spiros C

AU - Farrington, C Paddy

AU - Whitaker, Heather

AU - Hemingway, Harry

AU - Douglas, Ian

PY - 2015/4/21

Y1 - 2015/4/21

N2 - AimAntipsychotics increase the risk of stroke. Their effect on myocardial infarction remains uncertain because people prescribed and not prescribed antipsychotic drugs differ in their underlying vascular risk making between-person comparisons difficult to interpret. The aim of our study was to investigate this association using the self-controlled case series design that eliminates between-person confounding effects.Methods and resultsAll the patients with a first recorded myocardial infarction and prescription for an antipsychotic identified in the Clinical Practice Research Datalink linked to the Myocardial Ischaemia National Audit Project were selected for the self-controlled case series. The incidence ratio of myocardial infarction during risk periods following the initiation of antipsychotic use relative to unexposed periods was estimated within individuals. A classical case–control study was undertaken for comparative purposes comparing antipsychotic exposure among cases and matched controls. We identified 1546 exposed cases for the self-controlled case series and found evidence of an association during the first 30 days after the first prescription of an antipsychotic, for first-generation agents [incidence rate ratio (IRR) 2.82, 95% confidence interval (CI) 2.0–3.99] and second-generation agents (IRR: 2.5, 95% CI: 1.18–5.32). Similar results were found for the case–control study for new users of first- (OR: 3.19, 95% CI: 1.9–5.37) and second-generation agents (OR: 2.55, 95% CI: 0.93–7.01) within 30 days of their myocardial infarction.ConclusionWe found an increased risk of myocardial infarction in the period following the initiation of antipsychotics that was not attributable to differences between people prescribed and not prescribed antipsychotics.

AB - AimAntipsychotics increase the risk of stroke. Their effect on myocardial infarction remains uncertain because people prescribed and not prescribed antipsychotic drugs differ in their underlying vascular risk making between-person comparisons difficult to interpret. The aim of our study was to investigate this association using the self-controlled case series design that eliminates between-person confounding effects.Methods and resultsAll the patients with a first recorded myocardial infarction and prescription for an antipsychotic identified in the Clinical Practice Research Datalink linked to the Myocardial Ischaemia National Audit Project were selected for the self-controlled case series. The incidence ratio of myocardial infarction during risk periods following the initiation of antipsychotic use relative to unexposed periods was estimated within individuals. A classical case–control study was undertaken for comparative purposes comparing antipsychotic exposure among cases and matched controls. We identified 1546 exposed cases for the self-controlled case series and found evidence of an association during the first 30 days after the first prescription of an antipsychotic, for first-generation agents [incidence rate ratio (IRR) 2.82, 95% confidence interval (CI) 2.0–3.99] and second-generation agents (IRR: 2.5, 95% CI: 1.18–5.32). Similar results were found for the case–control study for new users of first- (OR: 3.19, 95% CI: 1.9–5.37) and second-generation agents (OR: 2.55, 95% CI: 0.93–7.01) within 30 days of their myocardial infarction.ConclusionWe found an increased risk of myocardial infarction in the period following the initiation of antipsychotics that was not attributable to differences between people prescribed and not prescribed antipsychotics.

KW - myocardial infarction

KW - Antipsychotic agents

KW - Self-controlled case series

KW - Case-control study

U2 - 10.1093/eurheartj/ehu263

DO - 10.1093/eurheartj/ehu263

M3 - Article

VL - 36

SP - 984

EP - 992

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 16

ER -