Cardiac-Related Mortality with Atypical Antipsychotics

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DESCRIPTION (provided by applicant): The increased mortality rate of persons with schizophrenia has been of concern for several decades and is known to be 2-3 times higher than the general population. Death from cardiovascular-related events are believed to occur more frequently in this population and may be rising annually possibly due to newer second-generation antipsychotic (SGA) medications. Since their introduction, the more tolerable SGAs have moved fairly quickly into first-line treatment. However, along with the increased use of the SGAs, much literature on weight gain and related consequences has emerged. These include metabolic changes such as glucose dysregulation and hyperlipidemia. Additionally, with clozapine, cardiomyopathy, cardiac arrhythmias, and myocarditis are known to occur. In order for policy makers and clinicians to continue to advocate and prescribe these medications and for patients to continue to take these expensive medications the long-term treatment associated with SGAs should be beneficial, cost-effective and most importantly, safe. This proposed study will identify deaths from a group of 4,436 patients who have been treated with either dsperidone or clozapine in the State of Maryland and included in the Clozapine Authorization and Monitoring Program Database or the Maryland Antipsychotic Database. Death certificates for all who have died, identified by the Social Secudty Death Index, will be collected from the Maryland Division of Vital Records. Cardiac-related deaths are hypothesized to occur more frequently in patients who have been treated with clozapine as weight gain, glucose dysregulation and myocarditis occur more frequently with clozapine than risperidone. Risk factors for cardiac-related mortality associated with both medications will also be determined. Additionally, this preliminary study will provide a necessary foundation to set up a mechanism to collect autopsy reports and additional important clinical information such as cardiac and diabetes history on a case-cohort of patients. Other future plans include longer term follow-up and the comparison of all marketed SGAs. This study will provide needed information on the relative risk of cardiac-related mortality from antipsychotics, specifically those treated with risperidone and clozapine. This study is important as data on long-term health outcomes with atypical antipsychotics is lacking from the literature.