Antipsychotics and cardiovascular risk: A case/non-case study

Psychiatry Res. 2018 Dec:270:341-347. doi: 10.1016/j.psychres.2018.09.014. Epub 2018 Sep 18.

Abstract

Severe mental disorders have been reported to be associated with an increased cardiovascular risk. To measure the potential risk excess as compared, not with the baseline cardiovascular risk for the general population, but with the cardiovascular risk associated with drug iatrogenia. 197 reported cases of cardiovascular adverse reaction to antipsychotic drugs as compared to the reported cases of this type of adverse reactions to drugs other than antipsychotics entered in the Spanish Pharmacovigilance System database (FEDRA) (1995-2018) in an observational case/non-case study. Risk estimates of association were reporting odds ratio (ROR), and, chi-square test (χ2). Overall disproportionality for the whole drug class was found [ROR 2.3 (95% CI 2.0-2.7)], χ2 = 127.07]. When the two types of antipsychotics (typical and atypical) were analysed separately, we also found statistically significant disproportionality, and this disproportionality is similar between both groups, with disproportionality measures around 2.30, with the confidence intervals not including the 1. The disproportionality observed suggests a risk excess that might be greater than expected, which holds particularly true for torsade de pointes, sudden death and cardiac arrhythmias in patients treated with any of the two types of antipsychotics. There was no significant risk for ischaemic heart disease.

Keywords: Antipsychotics atypical; Cardiovascular risk; Severe mental disorders; Typical.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Adverse Drug Reaction Reporting Systems
  • Aged
  • Aged, 80 and over
  • Antipsychotic Agents / therapeutic use*
  • Arrhythmias, Cardiac / epidemiology
  • Breast Feeding
  • Cardiovascular Diseases / epidemiology*
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Databases, Factual
  • Death, Sudden / epidemiology
  • Dietary Exposure
  • Female
  • Humans
  • Infant
  • Male
  • Mental Disorders / drug therapy*
  • Middle Aged
  • Myocardial Ischemia / epidemiology
  • Odds Ratio
  • Pharmacovigilance
  • Risk Factors
  • Spain / epidemiology
  • Stroke / epidemiology
  • Torsades de Pointes / epidemiology
  • Young Adult

Substances

  • Antipsychotic Agents