Antipsychotic Use and Myocardial Infarction in Older Patients With Treated Dementia Full Text
JAMA Internal Medicine, 04/24/2012
Pariente A et al. – Antipsychotic use is associated with a modest and time–limited increase in the risk of Myocardial Infarction (MI) among community–dwelling older patients treated with cholinesterase inhibitors.Methods
- A retrospective cohort of community–dwelling older patients who initiated cholinesterase inhibitor treatment was identified between January 1, 2000, and December 31, 2009, using the Quebec, Canada, prescription claims database.
- From this source cohort, all new AP users during the study period were matched with a random sample of AP nonusers.
- The risk of MI was evaluated using Cox proportional hazards models, adjusting for age, sex, cardiovascular risk factors, psychotropic drug use, and propensity scores.
- In addition, a self–controlled case series study using conditional Poisson regression modeling was conducted.
- Among the source cohort of 37 138 cholinesterase inhibitor users, 10 969 (29.5%) initiated AP treatment.
- Within 1 year of initiating AP treatment, 1.3% of them had an incident MI.
- Hazard ratios for the risk of MI after initiation of AP treatment were 2.19 (95% CI, 1.11–4.32) for the first 30 days, 1.62 (95% CI, 0.99–2.65) for the first 60 days, 1.36 (95% CI, 0.89–2.08) for the first 90 days, and 1.15 (95% CI, 0.89–1.47) for the first 365 days.
- The self–controlled case series study conducted among 804 incident cases of MI among new AP users yielded incidence rate ratios of 1.78 (95% CI, 1.26–2.52) for the 1– to 30–day period, 1.67 (95% CI, 1.09–2.56) for the 31– to 60–day period, and 1.37 (95% CI, 0.82–2.28) for the 61– to 90–day period.