Steven Marder, MD
What is the risk for sudden cardiac death associated with the use of 2 classes (typical and atypical) of antipsychotic agents?
Cohort study with 1 042 159 person-years of follow-up.
93 300 persons who were 30 to 74 years of age (mean age 46 y, 65% men), used antipsychotic drugs (44 218 used single typical antipsychotic drugs and 46 089 used single atypical antipsychotic drugs), were enrolled in Medicaid for ≥ 730 days, and were eligible for full pharmacy benefits and made regular use of health care services (filled ≥ 1 prescription and made ≥ 1 visit in each of the 2 preceding y). Exclusion criteria were high risk for death from noncardiac causes, residence in nursing home, recent hospital stay (discharged within previous 30 d), serious illness, or drug dependence. Each user of antipsychotic drugs was matched on age, sex, and first day of follow-up to 2 control patients (n =186 600, mean age 46 y, 65% men).
Data on use of antipsychotic drugs were obtained from Medicaid pharmacy files. Current use included the period between the time the prescription was filled and the end of the days of supply (up to a 7-d carryover from previous prescriptions). Indeterminate use included the period up to 90 days after last current use. Former use included any period not defined by current or indeterminate use.
Sudden cardiac death occurring in the community (database linkage to computerized death certificates).
1870 sudden cardiac deaths occurred. Current users of typical antipsychotic drugs had twice the adjusted rate of sudden cardiac death as nonusers (Table). Current users of atypical antipsychotic drugs had more than twice the adjusted rate of sudden cardiac death as nonusers (Table). Former users did not have an increased risk for sudden cardiac death (Table).
Both typical and atypical antipsychotic drugs were associated with increased risk for sudden cardiac death.
Associations between antipsychotic drug use and sudden cardiac death
*Adjusted for age, sex, race, urban residence, Medicaid enrollment, cohort entry year, cardiovascular risk, psychiatric comorbid conditions, and antipsychotic drug dose.
†Not statistically significant.
Marder S. Both typical and atypical antipsychotic agents were associated with increased risk for sudden cardiac death. Ann Intern Med. 2009;151:JC2–12. doi: 10.7326/0003-4819-151-4-200908180-02012
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Published: Ann Intern Med. 2009;151(4):JC2-12.
Cardiology, Rhythm Disorders and Devices.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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