Antipsychotic drug use and risk of stroke and myocardial infarction: a systematic review and meta-analysis
Open accessAbstract
The effect of antipsychotic (AP) drugs on risk of stroke and myocardial infarction (MI) remains unclear due to methodological limitations of, and inconsistencies across, existing studies. We aimed to systematically review studies reporting on the associations between AP drug use and stroke or MI risk, and to investigate whether associations differed among different sub-populations. We searched Medline, EMBASE, PsychINFO and Cochrane Library (from inception to May 28, 2017) for observational studies reporting on AP drug use and MI or stroke occurrence. We performed random-effects meta-analyses for each outcome, performing sub-groups analyses by study population – specifically general population (i.e. those not restricted to patients with a particular indication for AP drug use), people with dementia only and psychiatric illness only. Where feasible we performed subgroup analyses by AP drug class. From 7008 articles, we included 29 relevant observational studies, 19 on stroke and 10 on MI. Results of cohort studies that included a general population indicated a more than two-fold increased risk of stroke, albeit with substantial heterogeneity (pooled HR 2.31, 95% CI 1.13, 4.74, I 2 = 83.2%). However, the risk among patients with dementia was much lower, with no heterogeneity (pooled HR 1.16, 95% CI 1.00, 1.33, I 2 = 0%) and there was no clear association among studies of psychiatric populations (pooled HR 1.44, 95% CI 0.90, 2.30; substantial heterogeneity [I 2 = 78.8])). Associations generally persisted when stratifying by AP class, but few studies reported on first generation AP drugs. We found no association between AP drug use and MI risk (pooled HR for cohort studies: 1.29, 95% CI 0.88, 1.90 and case-control studies: 1.07, 95% CI 0.94, 1.23), but substantial methodological and statistical heterogeneity among a relatively small number of studies limits firm conclusions. AP drug use may be associated with an increased risk of stroke, but there is no clear evidence that this risk is further elevated in patients with dementia. Further studies are need to clarify the effect of AP drug use on MI and stroke risk in different sub-populations and should control for confounding by indication and stratify by AP drug class.
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In older adults, psychotropic use has been associated with risk of severe adverse effects such as falls, stroke and mortality.
“In older adults, psychotropic use has been associated with the risk of severe adverse effects such as falls [13–18], stroke [17, 19–22] and mortality [13, 23–25].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [21]
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- Authors
- Zivkovic, S., Koh, C. H., Kaza, N., & Jackson, C. A.
- Affiliations
- University of Edinburgh (GB)
- Corresponding author
- Jackson, Caroline A.
- Venue
- BMC Psychiatry
- Published
- 2019-06-20
- Volume
- 19
- Issue
- 1
- Pages
- 189-189
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC6585081
- OpenAlex
- W2951989134
- Cited by
- 65
- References
- 74
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 10 · 2023: 11 · 2022: 11 · 2021: 11 · 2020: 7 · 2019: 1
- FWCI
- 1.27
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- antipsychotic drugs, stroke risk, myocardial infarction risk, cardiovascular adverse events, dementia, mental illness, typical antipsychotics, subgroup analysis
- MeSH terms
- Dementia, Humans, Myocardial Infarction, Risk Factors, Antipsychotic Agents, Cohort Studies, Case-Control Studies, Stroke, Observational Studies as Topic
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