Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
Br J Clin Pharmacol. 2011 Dec;72(6):871-8. doi: 10.1111/j.1365-2125.2011.04043.x.
Patient populations that are prescribed antipsychotic agents have higher cardiovascular mortality rates. The risk of myocardial infarction is influenced by various factors that are more prevalent in patients with a mental illness. The aim of this review was to determine whether the use of antipsychotic agents is associated with the incidence of myocardial infarction in adults.
Using multiple sources, all studies of antipsychotic agents using myocardial infarction as primary or secondary outcome measures were considered for inclusion. Study populations were adult subjects who had been prescribed an antipsychotic agent at least once in their medical history.
It total, five studies were identified. Four studies with small numbers of events reported a moderate to strong effect of typical antipsychotic agents on the risk of myocardial infarction. The largest study had a favourable internal validity compared with all other studies and reported no association between the risk of myocardial infarction and current use of either atypical (relative risk 0.98, 95% confidence interval [CI] 0.88, 1.09) or typical antipsychotic agents (relative risk 0.99, 95% CI 0.96, 1.03).
Clinical and methodological heterogeneity between the studies in this review led to an inconclusive answer to the question whether the use of antipsychotics is associated with the incidence of myocardial infarction in adults. Whilst results conflicted, the largest study did not find an association between the use of antipsychotic agents and an increased risk of myocardial infarction.
服用抗精神病药物的患者人群心血管死亡率较高。心肌梗死的风险受到各种因素的影响，这些因素在精神疾病患者中更为普遍。本综述的目的是确定使用抗精神病药物是否与成年人心肌梗死的发生率有关。
使用多种来源，考虑了所有将心肌梗死作为主要或次要结局指标的抗精神病药物研究。研究人群为在其病史中至少一次开处过抗精神病药物的成年患者。
共确定了五项研究。四项研究报道了小数量事件的中等至强烈影响，表明典型抗精神病药物对心肌梗死风险有影响。最大的研究与所有其他研究相比具有良好的内部有效性，并且报告目前使用非典型（相对风险 0.98，95%置信区间 [CI] 0.88, 1.09）或典型抗精神病药物（相对风险 0.99，95% CI 0.96, 1.03）与心肌梗死风险之间没有关联。
本综述中研究之间的临床和方法学异质性导致对于使用抗精神病药物是否与成年人心肌梗死的发生率有关这个问题没有得出明确的答案。尽管结果存在冲突，但最大的研究并未发现使用抗精神病药物与心肌梗死风险增加之间存在关联。
