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Risk of Serious Cardiac Events in Older Adults Using Antipsychotic
Agents
Sandhya Mehta, MS; Hua Chen, MD, PhD; Michael Johnson, PhD; and Rajender R. Aparasu, MPharm, PhD
Am J Geriatr Pharmacother. 2011; 9: 120-132
Alicia Williams2012 PharmD CandidateMercer University COPHS
July 7, 2011
Typical Antipsychotics loxapine fluphenazine triflupromazine chlorprothixene haloperidol chlorpromazine thioridazine prochlorperazine promazine trifluperazine thiothexene molindone perphenazine acetophenazine mesoridazine paliperidone pimozide perphenazine-amitriptyline
Atypical Antipsychotics
clozapine olanzapine risperidone quetiapine ziprasidone aripiprazole
Background
Antipsychotic agents can cause cardiovascular events through multiple mechanisms:
prolongation of the QT interval causes orthostasis and tachyarrhythmias
Torsade de pointes
raised lupus anticoagulant and anticardiolipin antibody levels
can lead to increased risk of venous thromboembolism
increased occurrence of metabolic syndrome such as type 2 diabetes, weight gain, and hypertriglyceridemia
Background
Background
Background
Background
Objective
To compare the risk of serious cardiac events in older adults taking typical antipsychotics with those taking atypical antipsychotics
Study Design A propensity-matched retrospective
cohort study was conducted.
The base population included all older adults aged ≥50 years old who were on antipsychotics from July 1, 2000 to December 31, 2007.
No funding was received for this study.
Inclusion/Exclusion Criteria Participants must have been
continuously eligible 6 months before and 6 months after the index date Index date:
Antipsychotic initiation The first prescription fill date of
antipsychotic medication after at least 6 months without a prescription fill date for these medications
The minimum follow-up period was 6 months after the index date.
maximum: 1 year
Patient Demographics
A total of 5580 patients were selected in each antipsychotic users group after propensity score matching.
Intervention Prescription and medication information were
derived from the IMS LifeLink Health Plan Claims database.
The two groups were matched on a propensity score to minimize the baseline differences between the groups.
Survival analysis was conducted on the matched cohort to assess the risk of serious cardiovascular events between the two groups.
Primary Endpoint Hospitalizations or emergency
room visit due to serious cardiac events, including: thromboembolism, myocardial infarction, cardiac arrest, ventricular arrhythmias,
within one year after the index date
Results Serious cardiac events were found in:
666 (11.9%) of atypical antipsychotic users 698 (12.4%) of typical antipsychotic users
Survival analysis revealed that typical antipsychotic users were at increased risk of serious cardiovascular events hazard ratio = 1.21; 95% CI, 1.04-1.40
Conclusion Moderate increases in risk of serious
cardiac events are associated with older adults using typical antipsychotic agents compared with atypical users.
There is a strong need to assess the benefit-to-risk ratio of antipsychotics before prescribing them to a vulnerable population such as the elderly.
Comment The use of computer-recorded information
to capture data did not allow them to ascertain whether the participants actually used their dispensed medications.
The population referred to in the study comprised of community-dwelling older adults, and the results may not be generalizable to other settings.
Level of Evidence
Questions