Enger Cheryl, Weatherby Lisa, Reynolds Robert F, Glasser Dale B, Walker Alexander M
Ingenix Epidemiology, Riverside Center, Suite 3-120, 275 Grove Street, Auburndale, MA 02466, USA.
J Nerv Ment Dis. 2004 Jan;192(1):19-27. doi: 10.1097/01.nmd.0000105996.62105.07.
This study compared the risks of cardiovascular morbidity and mortality in people with schizophrenia who use antipsychotic medications to risks in individuals without schizophrenia in a large managed care organization. A sample of 1920 schizophrenia patients was matched by age, sex, date, and health plan to 9600 persons randomly selected from the health plan general membership. Death, myocardial infarction, arrhythmia, and new-onset diabetes were identified using a National Death Index search and medical claims records. The adjusted all-cause mortality rate in the group of treated schizophrenics was four times higher than in the control group regardless of whether patients were given a typical or an atypical antipsychotic medication. Users of typical antipsychotics had a fivefold higher risk of myocardial infarction than the control subjects. Among patients with schizophrenia, cardiovascular risk was inversely associated with intensity of use of antipsychotic drugs, suggesting that the observed risks may not be due to a simple or direct effect of drugs. Patients treated for schizophrenia had higher rates of new-onset diabetes than did the general population controls. This risk was most pronounced in persons with more intense exposure to drugs and appeared to be indistinguishable in users of typical antipsychotics, of atypical products, or of both.
在一个大型管理式医疗组织中，本研究比较了使用抗精神病药物的精神分裂症患者与无精神分裂症个体发生心血管疾病和死亡的风险。1920名精神分裂症患者样本在年龄、性别、日期和健康计划方面与从健康计划普通会员中随机抽取的9600人进行匹配。通过国家死亡指数搜索和医疗理赔记录来确定死亡、心肌梗死、心律失常和新发糖尿病情况。无论患者使用的是典型抗精神病药物还是非典型抗精神病药物，接受治疗的精神分裂症患者组经调整后的全因死亡率比对照组高四倍。使用典型抗精神病药物的患者发生心肌梗死的风险比对照组高五倍。在精神分裂症患者中，心血管风险与抗精神病药物的使用强度呈负相关，这表明观察到的风险可能并非药物的简单或直接作用所致。接受精神分裂症治疗的患者新发糖尿病的发生率高于普通人群对照组。这种风险在药物暴露更强烈的人群中最为明显，在使用典型抗精神病药物、非典型产品或两者都使用的患者中似乎没有差别。
