Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China.
Peking University Huilonguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
BMJ Open. 2021 Jan 31;11(1):e043259. doi: 10.1136/bmjopen-2020-043259.
To determine the association of long-term use of antipsychotics with the risk of dyslipidaemia.
A hospital-based cohort study.
Electronic health record data of adult mental health inpatients in all 19 specialised psychiatric hospitals in Beijing from 1 January 2005 to 31 December 2018 was obtained.
Participants were inpatients aged 18 years or older with at least two admissions, excluding those with diagnosed dyslipidaemia and fatty liver at the first admission. We included 22 329 adult inpatients with no dyslipidaemia and fatty liver at baseline. The exposure was antipsychotics use, defined as antipsychotics prescription in the treatment procedures of medical record preceding dyslipidaemia diagnosis during the follow-up period. 15 930 (71.34%) had antipsychotics use, and 6399 (28.66%) never had antipsychotics use. We used the length of follow-up as proxy for the duration of antipsychotics exposure.
The primary outcome was newly recorded dyslipidaemia defined by International Classification of Diseases, 10th Revision codes.
4069 inpatients had newly recorded dyslipidaemia during 73 418.07 person-years, the incidence rate was 5.54 per 100 person-years. The incidence rate was 7.22 per 100 person-years in the exposed group and 3.43 per 100 person-years in the unexposed group. Results of multivariate analysis showed that antipsychotics use was associated with higher risk of dyslipidaemia (adjusted HR, aHR 2.41, 95% CI 2.24 to 2.59, p<0.001), regardless of the duration of antipsychotics use. Inpatients aged 18-29 years had higher risk of dyslipidaemia (aHR 3.38, 95% CI 2.77 to 4.12, p=0.004) than those in other age groups. Inpatients without hypertension had substantially higher risk of dyslipidaemia after antipsychotic exposure.
Both short-term and long-term antipsychotics use was associated with higher risk of dyslipidaemia among Chinese inpatients with mental illness. Dyslipidaemia was especially prominent in young patients and those without hypertension.
确定长期使用抗精神病药物与血脂异常风险的关联。
基于医院的队列研究。
获取 2005 年 1 月 1 日至 2018 年 12 月 31 日期间北京 19 家专业精神病院所有 18 岁及以上精神科住院患者的电子健康记录数据。
参与者为至少两次入院的 18 岁及以上住院患者，不包括首次入院时即被诊断为血脂异常和脂肪肝的患者。我们纳入了 22329 名基线时无血脂异常和脂肪肝的成年住院患者。暴露因素为抗精神病药物的使用，定义为在随访期间血脂异常诊断前的病历治疗过程中开具的抗精神病药物处方。15930 人（71.34%）使用过抗精神病药物，6399 人（28.66%）从未使用过抗精神病药物。我们使用随访时间作为抗精神病药物暴露时间的替代指标。
主要结局为国际疾病分类，第 10 版代码定义的新记录血脂异常。
在 73418.07 人年中，4069 名患者出现新记录的血脂异常，发生率为 5.54/100 人年。暴露组的发生率为 7.22/100 人年，未暴露组的发生率为 3.43/100 人年。多变量分析结果表明，使用抗精神病药物与血脂异常风险增加相关（调整后的 HR，aHR 2.41，95%CI 2.24 至 2.59，p<0.001），无论抗精神病药物使用时间长短。18-29 岁的住院患者血脂异常风险较高（aHR 3.38，95%CI 2.77 至 4.12，p=0.004），高于其他年龄组。抗精神病药物暴露后，无高血压的住院患者血脂异常风险显著升高。
中国精神科住院患者短期和长期使用抗精神病药物均与血脂异常风险增加相关。血脂异常在年轻患者和无高血压患者中尤为突出。
