Association between antipsychotic use and acute ischemic heart disease in women but not in men: a retrospective cohort study of over one million primary care patients

Francisco TT Lai, Bruce Guthrie, Stewart W Mercer, Daniel Smith, Benjamin H K Yip, Gary K K Chung, The jockey, Roger Y Chung, Patsy Y K Chau, The jockey, The jockey, Samuel Y S Wong (Translator)

Research output: Contribution to journalArticlepeer-review

Abstract

Background:
Research comparing sex differences in the effects of antipsychotic medications on acute ischemic heart disease (IHD) is limited and the findings ambiguous. This study aimed to investigate these associations within a primary care setting.

Methods:
Hong Kong public general outpatient electronic records of patients aged 45+ during 2007 – 2010 were extracted, with the last consultation date as the baseline for a four-year follow-up period to observe acute IHD hospitalizations (2011 – 2014). Antipsychotic use was defined as any prescription over the previous 12 months from a list of 16 antipsychotics, while acute IHD was defined by ICD-9: 410.00 – 411.89. Both sex-specific and sex-combined (both sexes) mixed-effects Cox models (random intercept across 74 clinics) were implemented to examine the association and test the interaction between antipsychotics and sex.

Results:
Among 1,043,236 included patients, 17,780 (1.7%) were prescribed antipsychotics, and 8,342 (0.8%) developed IHD. In sex-specific analyses, antipsychotic prescription was associated with a 32% increased hazard rate of acute IHD among women (95% CI: 1.05 – 1.67) but not among men. A likelihood ratios test comparing sex-combined models with and without the interaction between antipsychotic use and sex suggested significant interaction (χ2 = 4.72, P = 0.030). The association between antipsychotic use and IHD among women attenuated and became non-significant when haloperidol was omitted from the operationalization of antipsychotic use (HR = 1.23, 95% CI: 0.95 – 1.60).

Conclusion:
Our results suggest that antipsychotic prescription is moderately associated with an increased risk of acute IHD among women in primary care and this relationship may be explained by specific antipsychotics. Further research should observe and capture the potential intermediary mechanisms and the dose-response relationship of this association to provide more rigorous evidence to establish causality and inform clinical practices.
Original languageEnglish
Article number289
JournalBMC Medicine
Volume18
Issue number289
DOIs
Publication statusPublished - 2 Nov 2020

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