Brauer Ruth, Smeeth Liam, Anaya-Izquierdo Karim, Timmis Adam, Denaxas Spiros C, Farrington C Paddy, Whitaker Heather, Hemingway Harry, Douglas Ian
Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Eur Heart J. 2015 Apr 21;36(16):984-92. doi: 10.1093/eurheartj/ehu263. Epub 2014 Jul 8.
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.
抗精神病药物会增加中风风险。其对心肌梗死的影响仍不确定，因为服用和未服用抗精神病药物的人群潜在血管风险不同，使得个体间比较难以解释。我们研究的目的是使用自我对照病例系列设计来调查这种关联，该设计可消除个体间的混杂效应。
在与心肌缺血国家审计项目相关联的临床实践研究数据链中，选取所有首次记录有心肌梗死且开具了抗精神病药物处方的患者进行自我对照病例系列研究。在个体内估计开始使用抗精神病药物后的风险期内心肌梗死的发病率与未暴露期的发病率之比。为了进行比较，开展了一项经典病例对照研究，比较病例组和匹配对照组中的抗精神病药物暴露情况。我们为自我对照病例系列确定了1546例暴露病例，并发现，在首次开具抗精神病药物处方后的前30天内，第一代药物[发病率比（IRR）2.82，95%置信区间（CI）2.0 - 3.99]和第二代药物（IRR：2.5，95% CI：1.18 - 5.32）存在关联证据。在心肌梗死发生后30天内，第一代（比值比：3.19，95% CI：1.9 - 5.37）和第二代药物（比值比：2.55，95% CI：0.93 - 7.01）新使用者的病例对照研究也得到了类似结果。
我们发现，开始使用抗精神病药物后的一段时间内心肌梗死风险增加，这并非归因于服用和未服用抗精神病药物人群之间的差异。
