Antipsychotic drugs and risks of myocardial infarction: a self-controlled case series study.
Antipsychotic drugs and risks of myocardial infarction: a self-controlled case series study.
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DOI：
10.1093/eurheartj/ehu263
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发表时间：
2015-04-21
影响因子：
39.3
通讯作者：
Douglas I
中科院分区：
文献类型：
--
作者：
Brauer R;Smeeth L;Anaya-Izquierdo K;Timmis A;Denaxas SC;Farrington CP;Whitaker H;Hemingway H;Douglas I
抗精神病药物会增加中风的风险。抗精神病药物对心肌梗死的影响仍不确定，因为处方和未处方抗精神病药物的人在潜在的血管风险方面存在差异，使得人与人之间的比较难以解释。我们研究的目的是使用排除人与人之间混杂效应的自我对照病例系列设计来调查这种关联。选择首次记录心肌梗死并在与心肌缺血国家审计项目相关的临床实践研究数据链中确定抗精神病药处方的所有患者进行自我对照病例系列研究。在个体内估计了开始使用抗精神病药物后的风险期相对于未暴露期心肌梗死的发病率。进行了一项经典的病例对照研究，以比较病例和匹配对照之间的抗精神病药物暴露情况。我们确定了1546例自我对照病例系列的暴露病例，并发现了第一代抗精神病药[发病率比（IRR）2.82，95%置信区间（CI）2.0-3.99]和第二代抗精神病药（IRR：2.5，95% CI：1.18-5.32）在首次处方抗精神病药后的前30天内存在相关性的证据。在心肌梗死30天内首次使用第一代（OR：3.19，95% CI：1.9-5.37）和第二代药物（OR：2.55，95% CI：0.93-7.01）的病例对照研究中发现了相似的结果。我们发现，在开始使用抗精神病药物后的一段时间内，心肌梗死的风险增加，这并不归因于处方和未处方抗精神病药物的人群之间的差异。
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. 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. 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.
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影响因子：
1.9
作者：
Enger, C;Weatherby, L;Walker, AM
通讯作者：
Walker, AM
DOI：
10.1136/bmj.f2350
发表时间：
2013-05-20
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Herrett E;Shah AD;Boggon R;Denaxas S;Smeeth L;van Staa T;Timmis A;Hemingway H
通讯作者：
Hemingway H
DOI：
10.1056/nejmoa0806994
发表时间：
2009-01-15
期刊：
The New England journal of medicine
影响因子：
--
作者：
Ray WA;Chung CP;Murray KT;Hall K;Stein CM
通讯作者：
Stein CM
影响因子：
2.1
作者：
Farrington, C. Paddy;Whitaker, Heather J.;Hocine, Mounia N.
通讯作者：
Hocine, Mounia N.
影响因子：
--
作者：
Douglas, Ian J.;Smeeth, Liam
通讯作者：
Smeeth, Liam