Meta-analyses have found conflicting evidence on the link between antipsychotics and cerebrovascular events (CVEs). The primary aim of this study was to evaluate the association between any antipsychotic prescription and CVEs in Italian elderly; second, to compare the effect of typical and atypical antipsychotics on CVEs; and, third, to investigate the effect of antipsychotics on CVEs in the subgroup of persons co-prescribed with acetilcholinesterase inhibitors (AChEI). Administrative claims from community-dwelling people aged 65 to 94 years living in Northern Italy were analysed using a retrospective case-control design, from 2003 to 2005. The primary outcome measure was a hospital discharge diagnosis of CVEs during 2005. Four age-, gender-, and local health unit-matched controls were identified for each case. Antihypertensive drugs, anticoagulants, platelet inhibitors, antidiabetics, lowering lipid drugs and AChEI were used as covariates in conditional logistic regression models testing the odds ratio for CVEs due to antipsychotics use. 3855 cases of CVEs were identified and matched with 15420 controls. In multi-adjusted models, the association of any antipsychotics, typical or atypical with CVEs was not significant. When antipsychotics were categorized according to number of boxes prescribed during the observational period, being prescribed with at least 19 boxes of typical antipsychotics was significantly associated with CVEs (OR=2.4;95%CI=1.08-5.5). An interaction was found between any antipsychotic and AChEI co-prescription on CVEs (OR=0.46;95%CI=0.23-0.92). In conclusions, only typical antipsychotics were associated with an increased odd of CVEs but the association was duration-dependent. Persons prescribed simultaneously with AChEI and antipsychotics may be at a lower risk of CVEs.
Antipsychotics prescription and cerebrovascular events in Italian older persons
MARENGONI, Alessandra
2013-01-01
Abstract
Meta-analyses have found conflicting evidence on the link between antipsychotics and cerebrovascular events (CVEs). The primary aim of this study was to evaluate the association between any antipsychotic prescription and CVEs in Italian elderly; second, to compare the effect of typical and atypical antipsychotics on CVEs; and, third, to investigate the effect of antipsychotics on CVEs in the subgroup of persons co-prescribed with acetilcholinesterase inhibitors (AChEI). Administrative claims from community-dwelling people aged 65 to 94 years living in Northern Italy were analysed using a retrospective case-control design, from 2003 to 2005. The primary outcome measure was a hospital discharge diagnosis of CVEs during 2005. Four age-, gender-, and local health unit-matched controls were identified for each case. Antihypertensive drugs, anticoagulants, platelet inhibitors, antidiabetics, lowering lipid drugs and AChEI were used as covariates in conditional logistic regression models testing the odds ratio for CVEs due to antipsychotics use. 3855 cases of CVEs were identified and matched with 15420 controls. In multi-adjusted models, the association of any antipsychotics, typical or atypical with CVEs was not significant. When antipsychotics were categorized according to number of boxes prescribed during the observational period, being prescribed with at least 19 boxes of typical antipsychotics was significantly associated with CVEs (OR=2.4;95%CI=1.08-5.5). An interaction was found between any antipsychotic and AChEI co-prescription on CVEs (OR=0.46;95%CI=0.23-0.92). In conclusions, only typical antipsychotics were associated with an increased odd of CVEs but the association was duration-dependent. Persons prescribed simultaneously with AChEI and antipsychotics may be at a lower risk of CVEs.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
