By Anthony J. Brown, MD
NEW YORK (Reuters Health) – Patients treated with moderate doses of antipsychotics are at more than twice the risk for sudden cardiac death as nonusers of these medications, according to a report in the December issue of the Archives of General Psychiatry.
However, it is unclear whether this finding applies to the newer antipsychotic agents that were released after the introduction of risperidone in 1994.
Dr. Purushottam B. Thapa, from the University of Arkansas for Medical Sciences in Little Rock, and colleagues performed a retrospective cohort study of 481,744 subjects to determine the impact of antipsychotic use on sudden cardiac death risk.
The subjects were divided into four groups based on antipsychotic use. The groups included current moderate dose users (> 100-mg thioridazine equivalents), current low dose users, former users (use within the last year but not currently), and nonusers. Because the data were collected from 1988 to 1993, the subjects were not treated with the newer antipsychotic agents.
Nearly 1500 subjects experienced sudden cardiac death. Current moderate dose users were significantly more likely than nonusers to experience sudden cardiac death (p < 0.001), with a rate ratio of 2.39. The rate ratio in low-dose users and former users was 1.30 and 1.20, respectively.
The risk for sudden cardiac death was greatest among current moderate dose users with severe cardiovascular disease, the researchers note. These patients were 3.53 times more likely to experience sudden cardiac death than comparable nonusers (p < 0.001).
"There have been case reports linking antipsychotic use to sudden cardiac death, but no controlled epidemiologic studies had been done," Dr. Thapa told Reuters Health.
"The take-home message is that one needs to be particularly careful when prescribing antipsychotics to patients with a history of heart disease," Dr. Thapa said. "The effects appear to be dose-related so it is important to try to stabilize patients on the minimum effective dose."
Dr. Thapa noted that "the newer antipsychotic agents have a much better safety profile than the older agents." However, "these agents do prolong the QT interval so it is possible that they could also be linked to an increased risk of sudden cardiac death," he said. "Clearly, a possible association with the newer agents needs to be studied further."
Arch Gen Psychiatry 2001;58:1161-1170.
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