January 30, 2009

New antipsychotics no better for heart

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Wayne Ray, Ph.D.

New antipsychotics no better for heart

Vanderbilt researchers have found that new, or atypical, antipsychotic drugs carry the same cardiovascular risk as older, or typical, antipsychotic drugs and both double a patient's chance of dying from sudden cardiac death.

These data are strong evidence against the hypothesis that the newer drugs have a better cardiovascular safety profile, the research team reported in the Jan. 15 issue of the New England Journal of Medicine.

Wayne Ray, Ph.D., professor of Preventive Medicine, Michael Stein., M.B., Ch.B., professor of Medicine and Pharmacology, and Katherine Murray, M.D., associate professor of Medicine and Pharmacology, have been studying the effect of antipsychotic drugs on the cardiovascular system for more than 10 years.

It's been known for some time that typical antipsychotics used to treat psychosis increase the risk of sudden cardiac death because they can interfere with heart rhythm.
“When the atypical drugs were introduced, there was hope they were less likely to cause this effect,” Ray said. “Because less was known about this newer class of drugs, we decided to study their cardiovascular safety.”

The atypical antipsychotic agents, sometimes called “novel” antipsychotic agents, are a group of drugs which are different chemically from the older drugs used to treat schizophrenia, attention deficit hyperactivity disorder (ADHD) and dementia. Atypical drugs, which include the commonly prescribed Risperdal, Zyprexa and Seroquel, also have different side effects than typical ones.

The atypical antipsychotics have one important advantage over their older counterpart: They are less likely to cause very serious movement disorders like Parkinson's disease and tardive dyskinesia.

“This benefit may have overshadowed other safety considerations such as cardiovascular risk,” Ray said.

The research team conducted a retrospective cohort study of Medicaid enrollees in Tennessee, which included 93,000 users of single typical and atypical drugs and 186,600 nonusers of antipsychotic drugs over a 15-year period ending in 2005. They found patients taking either type of drug were twice as likely to die of sudden cardiac failure as those not taking the drugs — equal to three deaths for every 1,000 patients.
Their research findings may have some serious implications for the 3 million people who use them.

“In my opinion, antipsychotic drug use should be reserved for people for whom there are no alternatives,” Ray said.

This includes people who suffer from schizophrenia and its related psychoses. Anyone considering going on antipsychotic medication should undergo a cardiovascular workup to address risk factors, Ray recommended.

The FDA has approved the use of antipsychotic drugs for bipolar disorder, but mood stabilizers would be an effective, safer choice, Ray said. Use of the drugs to treat ADHD and behavior disorders related to dementia hasn't been reviewed by the FDA.
“For such off-label use, antipsychotics should be used sparingly and as a last resort,” Ray said.

Collaborators on the study include Cecelia Chung, M.D., M.P.H., and Kathie Ball, B.S.