Evaluation of stroke risk associated with the use of typical or atypical antipsychotics among patients with cardiovascular diseases

Abstract

Background: Concerns regarding stroke safety associated with the use of atypical antipsychotics among dementia patients have been raised. Although observational studies have found conflicting associations of stroke risk with the use of typical or atypical antipsychotics among the elderly with or without dementia, patients with cardiovascular diseases (CVDs), a high-risk for the stroke population, have not been examined. Little evidence has been provided regarding comparison of the stroke risk between the two antipsychotic classes. This study aimed to evaluate the comparative stroke risk with atypical versus typical antipsychotic use among CVD patients. Materials and Methods: We conducted a population-based nested case-control study analyzing the Taiwan National Health Insurance Research Database from January 1, 1996 to December 31, 2007. A total of 7,460 CVD patients was followed-up, among which 580 hospitalized cases with stroke were identified and matched to 5,398 randomly selected controls. Conditional logistic regressions were employed to quantify the difference in stroke risk associated with atypical versus typical antipsychotics. Results: Any use and current use of atypical antipsychotics were associated with a 1.67-fold (95% confidence interval [CI], 1.21-2.30) and a 2.30-fold (95% CI, 1.56-3.40) increased risk of stroke relative to any typical antipsychotic use, respectively. The stroke risk associated with current use of atypical antipsychotics persisted even compared with current use of typical antipsychotics (adjusted odds ratio, 1.53; 95% CI, 1.02-2.33). Conclusions: Use of atypical antipsychotics is associated with an increased risk of stroke requiring hospitalization compared to typical antipsychotic use among CVD patients. Healthcare professionals should take this risk into account when choosing between typical and atypical antipsychotic treatments among CVD patients.