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Risk of acute coronary syndrome in elderly users of antipsychotic drugs: a nested case-control study
  1. Bart C Kleijer1,2,
  2. Huiberdina L Koek2,
  3. Rob J van Marum2,3,
  4. Paul A F Jansen2,
  5. Toine C G Egberts4,5,
  6. Eibert R Heerdink2,4
  1. 1GeriMedica Medical Practice for Frail Elderly, Utrecht, The Netherlands
  2. 2Geriatric Department, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
  4. 4Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
  5. 5Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to Dr Huiberdina L Koek, Geriatric Department, B05.256, University Medical Center Utrecht, PO Box 85500, 3500 GA, Utrecht, The Netherlands; h.l.koek{at}


Objective To examine the association between antipsychotic use and the risk of acute coronary syndrome (ACS) in elderly de novo users of antipsychotics.

Design A community-based nested case-control study.

Setting Pharmacy dispensing records from community pharmacies in The Netherlands were linked to hospital discharge records of 950 000 community-dwelling residents from 1998 to 2008.

Patients Cases were 2803 patients aged 60 years or older, with a first hospital admission for ACS identified within a cohort of 26 157 elderly persons with at least one antipsychotic prescription (de novo users). For each case, four controls with no hospitalisation for ACS (n=11 024) were randomly selected from the same cohort, matched by age, gender and duration of registration in the database.

Main outcome measures Relative risks, expressed as ORs, for ACS associated with antipsychotic drug use adjusted for comorbidity.

Results Current exposure to antipsychotics was associated with a decreased risk of hospitalisation for ACS compared with past users (adjusted OR 0.5, 95% CI 0.5 to 0.6). Cumulative use up to 100 Defined Daily Doses was also associated with a decreased risk of hospitalisation (OR 0.7, CI 0.6 to 0.8). No differences in risk were found between typical and atypical antipsychotics, current dosage or different degrees of serotonergic, histaminergic or adrenergic affinity of the antipsychotic.

Conclusions A decreased risk of hospitalisation for ACS in elderly patients currently using antipsychotics was found. Further research is needed to confirm our results and to determine whether there is a cardioprotective effect or a high non-referral rate in elderly antipsychotic users with ACS.

  • Acute coronary syndrome
  • antipsychotics
  • aged
  • psychotropic drugs
  • myocardial ischaemia
  • coronary artery disease
  • risk factors
  • epidemiology

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  • Competing interests All authors declare: no support from any institution for the submitted work; no financial relationships with any institutions that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study, and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Ethics approval The ethics approval was achieved as the study design was a medical record linkage study (data linked in an anonymous way using a probabilistic algorithm).

  • Provenance and peer review Not commissioned; internally peer reviewed.