The association between antipsychotic agents and the risk of myocardial infarction: a systematic review

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • An unfavourable risk profile for myocardial infarction (MI) is associated with various lifestyle factors and co‐morbidities that are more prevalent among patients with severe mental illness. • Patient populations that are prescribed antipsychotic agents have a higher cardiovascular mortality rate than the general population. • The association between the use of antipsychotic agents and any increase in the risk of MI is unclear. WHAT THIS STUDY ADDS • The aim of this systematic literature review was to assess the relationship between antipsychotic agents and MI. • Substantial clinical and methodological heterogeneity between the five studies in this review led to an inconclusive answer to the question whether the use of antipsychotics is associated with the incidence of MI in adults. • The largest study had a favourable internal validity compared with the other studies and did not find an association between the use of antipsychotic agents and an increased risk of MI. AIM Patient populations that are prescribed antipsychotic agents have higher cardiovascular mortality rates. The risk of myocardial infarction is influenced by various factors that are more prevalent in patients with a mental illness. The aim of this review was to determine whether the use of antipsychotic agents is associated with the incidence of myocardial infarction in adults. METHODS Using multiple sources, all studies of antipsychotic agents using myocardial infarction as primary or secondary outcome measures were considered for inclusion. Study populations were adult subjects who had been prescribed an antipsychotic agent at least once in their medical history. RESULTS It total, five studies were identified. Four studies with small numbers of events reported a moderate to strong effect of typical antipsychotic agents on the risk of myocardial infarction. The largest study had a favourable internal validity compared with all other studies and reported no association between the risk of myocardial infarction and current use of either atypical (relative risk 0.98, 95% confidence interval [CI] 0.88, 1.09) or typical antipsychotic agents (relative risk 0.99, 95% CI 0.96, 1.03). CONCLUSION Clinical and methodological heterogeneity between the studies in this review led to an inconclusive answer to the question whether the use of antipsychotics is associated with the incidence of myocardial infarction in adults. Whilst results conflicted, the largest study did not find an association between the use of antipsychotic agents and an increased risk of myocardial infarction.