Table of Contents
Cardiovascular Psychiatry and Neurology
Volume 2013 (2013), Article ID 647476, 13 pages
http://dx.doi.org/10.1155/2013/647476
Clinical Study

Risk of Mortality (including Sudden Cardiac Death) and Major Cardiovascular Events in Users of Olanzapine and Other Antipsychotics: A Study with the General Practice Research Database

1Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN 46285, USA
2Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London SW1W 9SZ, UK
3Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
4London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK

Received 1 July 2013; Revised 10 October 2013; Accepted 15 October 2013

Academic Editor: Kenji Hashimoto

Copyright © 2013 Meghan E. Jones et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective. Assess risk of cardiac events and mortality among users of olanzapine and other antipsychotics relative to nonusers. Methods. The General Practice Research Database was used to identify cohorts of antipsychotic users and nonusers with psychiatric illness. Outcomes included cardiac mortality, sudden cardiac death (SCD), all-cause mortality (excluding suicide), coronary heart disease (CHD), and ventricular arrhythmias (VA). Results. 183,392 antipsychotic users (including 20,954 olanzapine users) and 193,920 psychiatric nonusers were identified. There was a significantly higher rate of cardiac mortality (adjusted RR [aRR]: 1.53, CI, 1.12–2.09) in olanzapine users relative to psychiatric nonusers, consistent with findings for both atypical and typical antipsychotics. Relative to psychiatric nonusers, no increased risk of all-cause mortality was observed among olanzapine users (aRR: 1.04, CI, 0.93–1.17), but elevated all-cause mortality risk was observed when compared to all antipsychotic users (aRR: 1.75, CI, 1.64–1.87). There was no increased risk of CHD or VA among olanzapine users relative to psychiatric nonusers, consistent with findings for atypical but not typical antipsychotics. SCD cases were uncommon. Conclusions. Use of antipsychotic agents was associated with increased risk of all-cause and cardiac mortality. Patients treated with olanzapine were found to be at increased risk of cardiac mortality versus psychiatric nonusers.