Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan.
Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
Psychiatry Clin Neurosci. 2020 Nov;74(11):594-601. doi: 10.1111/pcn.13116. Epub 2020 Aug 17.
Research regarding the effects of age in patients with schizophrenia taking antipsychotics on the risk of sudden cardiac death is lacking. We determined the effect of patient age on the association between exposure to antipsychotics and the risk of sudden cardiac death in a nationwide schizophrenia cohort.
From the Taiwan National Health Insurance Research Database and Department of Health Death Certification System, data of 1836 patients with schizophrenia who had experienced sudden cardiac death between 2000 and 2016 were included. A case-crossover design by using a 14-day window was applied, and subgroup analyses were performed by stratifying patients into three age subgroups (<45, 45-65, and >65 years) to assess the effect of age on the risk of sudden cardiac death in patients taking antipsychotics.
No association between exposure to antipsychotic agents and sudden cardiac death risk was found in patients aged >65 years who were characterized by a high burden of medical illnesses. However, zotepine significantly increased the risk of sudden cardiac death in patients aged <45 years (adjusted relative risk [RR] = 2.68, P = 0.046). Flupentixol (adjusted RR = 5.30, P = 0.004) and risperidone (adjusted RR = 1.68, P = 0.01) significantly elevated the risk of sudden cardiac death in patients aged 45-65 years.
This study suggests that individual antipsychotics pose different risks of sudden cardiac death in patients with schizophrenia across their lifespan. Clinicians should consider patient age when evaluating the risks and benefits of antipsychotic treatment.
关于服用抗精神病药的精神分裂症患者年龄对心源性猝死风险影响的研究较少。我们确定了患者年龄对全国性精神分裂症队列中抗精神病药物暴露与心源性猝死风险之间关联的影响。
从台湾全民健康保险研究数据库和卫生署死亡证明系统中，纳入了 2000 年至 2016 年期间经历心源性猝死的 1836 例精神分裂症患者的数据。采用 14 天窗口的病例交叉设计，并通过分层患者为<45 岁、45-65 岁和>65 岁三个年龄亚组，评估年龄对服用抗精神病药物的患者心源性猝死风险的影响。
在患有多种疾病的老年 (>65 岁) 患者中，抗精神病药物暴露与心源性猝死风险之间没有关联。然而，佐替平显著增加了<45 岁患者的心源性猝死风险（调整后的相对风险 [RR] = 2.68，P = 0.046）。氟哌啶醇（调整后的 RR = 5.30，P = 0.004）和利培酮（调整后的 RR = 1.68，P = 0.01）显著增加了 45-65 岁患者的心源性猝死风险。
本研究表明，在精神分裂症患者的整个生命周期中，不同的抗精神病药物对心源性猝死的风险不同。临床医生在评估抗精神病药物治疗的风险和益处时应考虑患者的年龄。
