Cardiology, Improving Outcomes, Mythbusting

Crazy Gets Sick Too.

This paper examines 57,000 patients who had a a new diagnosis of schizophrenia, dementia, or “mood disorders” who were initiated on antipsychotics within 120 days of Acute Myocardial Infarction (AMI) – defined by receiving PCI, fibrinolytics, CABG, and/or antiplatelet therapy. Those with known comorbid cardiomyopathy, or a diagnosis of pericarditis, aortic dissection, or coronary aneurysm were excluded.

Essentially, the risk of having an MI was increased in the first month of initiation of first or second generation anti-psychotics, as well as with an increased antipsychotic dose within 4 months from initial psychiatric diagnosis. Males, elderly patients, and those with dementia had an increased risk, and those that were healthier, without diabetes, hypertension, or high cholesterol were also at an increased risk – all in comparison to a similar spectrum of patients who were started on benzodiazepenes or non-benzodiazepene hypnotics. The OR for AMI with first generation anti-psychotics was 2.32, and 2.74 for second-generation anti-psychotics. The OR for AMI after initiation of anti-psychotics within one month? 5.46!

For the most part, I like this study – it examines a large number of patients, and has a reasonable comparison (anti-psychotics vs benzos vs non-benzo hypnotics). I don’t like that they don’t provide a breakdown of interventions – if 95% of the patients were only initiated on anti-platelet therapy, then I’m not so sure of the validity of the article. Also, it is a Taiwan study, and the authors acknowledge that they may metabolize drugs differently than other ethnic groups, so they caution that their results may not be applicable to all populations.

Regardless, I think the message is clear and broadly applicable: crazy gets sick too, sometimes more than the general population.

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