Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China.
Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China.
BMJ Ment Health. 2023 Jun;26(1). doi: 10.1136/bmjment-2022-300501.
The association between antipsychotics and cardiovascular diseases (CVDs) remains significant yet unestablished, especially in Chinese populations.
To investigate the risk of CVDs associated with antipsychotics among Chinese individuals with schizophrenia.
We conducted a nested case-control study on individuals diagnosed with schizophrenia in Shandong, China. The case group included individuals diagnosed with incident CVDs between 2012 and 2020. Each case was randomly matched with up to three controls. We used weighted logistic regression models to assess the risk of CVDs associated with antipsychotics and restricted cubic spline analysis to explore the dose-response relationship.
In total, 2493 cases and 7478 matched controls were included in the analysis. Compared with non-users, any antipsychotics use was associated with higher risk of any CVDs (weighted OR=1.54, 95% CI 1.32 to 1.79), with the risk mainly driven by ischaemic heart diseases (weighted OR=2.26, 95% CI 1.71 to 2.99). Treatments with haloperidol, aripiprazole, quetiapine, olanzapine, risperidone, sulpiride and chlorpromazine were associated with increased risk of CVDs. A non-linear dose-response relationship between dosage of antipsychotics and risk of CVDs was observed, with a sharp increase in risk in the beginning and then flattening out with higher doses.
Use of antipsychotics was associated with increased risk of incident CVDs among individuals with schizophrenia, and the risk varied substantially among different antipsychotics and specific CVDs.
Clinicians should consider the cardiovascular risk of antipsychotics and choose the appropriate type and dose of drugs in the treatment of schizophrenia.
抗精神病药物与心血管疾病（CVDs）之间的关联仍然存在，但尚未确定，尤其是在中国人群中。
研究中国精神分裂症患者使用抗精神病药物与 CVDs 的相关性。
我们在中国山东开展了一项针对精神分裂症患者的巢式病例对照研究。病例组包括 2012 年至 2020 年间确诊为 CVDs 的患者。每个病例随机匹配最多 3 个对照。我们使用加权 logistic 回归模型评估抗精神病药物与 CVDs 风险的相关性，并采用限制立方样条分析探索剂量-反应关系。
共纳入 2493 例病例和 7478 例匹配对照。与未使用者相比，任何抗精神病药物的使用均与 CVDs 风险增加相关（加权 OR=1.54，95%CI 1.32 至 1.79），其风险主要由缺血性心脏病驱动（加权 OR=2.26，95%CI 1.71 至 2.99）。使用氟哌啶醇、阿立哌唑、喹硫平、奥氮平、利培酮、舒必利和氯丙嗪治疗与 CVDs 风险增加相关。抗精神病药物剂量与 CVDs 风险之间存在非线性剂量-反应关系，在开始时风险急剧增加，然后随着剂量增加而趋于平稳。
精神分裂症患者使用抗精神病药物与 CVDs 发生率增加相关，且不同抗精神病药物和特定 CVDs 的风险差异较大。
临床医生在治疗精神分裂症时应考虑抗精神病药物的心血管风险，并选择合适的药物类型和剂量。
