DALLAS – Elderly patients who started treatment with an antipsychotic drug had a substantially increased risk for a major adverse cardiovascular disease event, especially during the first month on treatment, according to Danish national records from more than 1 million people.
The risk remained elevated even when the analysis focused on elderly people who were aged 70 years or older and were without cardiovascular disease or dementia at the time of their first use of an antipsychotic medication, Dr. Charlotte Andersson and her associates reported in a poster at the American Heart Association scientific sessions.
Treatment was linked with a significantly increased rate of major adverse cardiovascular events (MACE) at some time during follow-up for all eight antipsychotic drugs studied in detail: haloperidol (Haldol), flupentixol (Fluanxol), chlorprothixene, levomepromazine (Nozinan), quetiapine (Seroquel), risperidone (Risperdal), olanzapine, and ziprasidone (Geodon), reported Dr. Andersson, a researcher at Gentofte Hospital in Copenhagen. The MACE association was relatively weak for ziprasidone, but it was robust for the other seven agents.
The study included 1,235,869 Danes aged 70 years or older during 1997-2009 who had not previously been treated with an antipsychotic drug. During the period studied, 100,140 (8%) of these people started treatment with an antipsychotic drug. During follow-up the researchers tallied the incidence of MACE (the combined rate of nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death).
Overall, use of an antipsychotic drug for more than 1 year was linked with a roughly doubled rate of MACE after adjustment for several demographic and clinical factors, including age, gender, diabetes, renal disease, dementia, and schizophrenia. The adjusted relative increase in MACE was even higher during the first 30 days of treatment for most of the eight drugs.
For example, during the first 30 days following the start of treatment, patients treated with any haloperidol dosage had a roughly fivefold increased adjusted MACE rate compared with people not receiving an antipsychotic. The relative risk was highest during the first 30 days in patients on the highest haloperidol dosages, 2 mg/day or more, who had a 10-fold increased MACE rate.
Similar increases in adjusted MACE rates were seen in patients treated with haloperidol for 1-12 months, as well as in those treated for more than a year, although with longer follow-up the adjusted relative risk was about two- to threefold above background. Similar risk patterns also existed in the subgroup of patients who were treated with haloperidol and were free from cardiovascular disease at baseline, as well as in those free from dementia at baseline.
Dr. Andersson and her associates said that they had no disclosures.
On Twitter @mitchelzoler