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

Table 3

Relative risks of all-cause mortality (excluding suicide) and cardiovascular outcomes for current users of various types of antipsychotics versus nonuser psychiatric controls.

Outcome	Exposure type	Number of events	PY	Incidence rate per 1000 PY; (95% CI)	Age-and sex-adjusted relative risk (RR) (95% CI)	Fully adjusted RR (aRR); (95% CI)
All-cause mortality	Nonuser psychiatric	7765	307,276	25.3 (24.7–25.8)	Reference	Reference
	Atypical or typical	23,841	276,892	86.1 (85.0–87.2)	2.15 (2.10–2.21)^‡	1.75 (1.64–1.87)^‡
	Atypical	7356	94,112	78.2 (76.4–80.0)	1.76 (1.71–1.82)^‡	1.52 (1.40–1.64)^‡
	Typical	15473	167,005	92.7 (91.2–94.1)	2.34 (2.28–2.41)^‡	1.82 (1.69–1.98)^‡
	Olanzapine	1305	34,985	37.3 (35.3–39.4)	1.40 (1.32–1.48)^‡	1.04 (0.93–1.17)
Cardiac mortality	Nonuser psychiatric	1289	200,988	6.4 (6.1–6.8)	Reference	Reference
	Atypical or typical	2478	145,643	17.0 (16.4–17.7)	1.62 (1.52–1.74)^‡	1.72 (1.42–2.07)^‡
	Atypical	1200	73,284	16.4 (15.5–17.3)	1.47 (1.36–1.59)^‡	1.74 (1.40–2.14)^‡
	Typical	1180	64,913	18.2 (17.2–19.3)	1.78 (1.64–1.92)^‡	1.88 (1.49–2.39)^‡
	Olanzapine	206	26,765	7.7 (6.7–8.8)	1.25 (1.07–1.44)^‡	1.53 (1.12–2.09)^‡
SCD—primary definition	Nonuser psychiatric	10	23,872	0.4 (0.2–0.8)	Reference	Reference
	Atypical or typical	44	16,144	2.7 (2.0–3.7)	5.76 (2.90–11.45)^‡	5.76 (2.90–11.45)^‡
	Atypical	21	10,201	2.1 (1.3–3.2)	0 (NC)	0 (NC)
	Typical	21	5415	3.9 (2.4–5.9)	0 (NC)	0 (NC)
	Olanzapine	6	3454	1.7 (0.6–3.8)	0 (NC)	0 (NC)
SCD—secondary definition	Nonuser psychiatric	98	23,873	4.1 (3.3–5.0)	Reference	Reference
	Atypical or typical	178	16,144	11.0 (9.5–12.8)	2.36 (1.84–3.02)^‡	2.15 (1.64–2.81)^‡
	Atypical	90	10,201	8.8 (7.1–10.8)	1.93 (1.45–2.57)^‡	1.79 (1.33–2.42)^‡
	Typical	78	5415	14.4 (11.4–18.0)	2.82 (2.09–3.80)^‡	3.99 (1.29–12.40)^†
	Olanzapine	10	3454	2.9 (1.4–5.3)	1.33 (0.69– 2.57)	0 (NC)
SCD—tertiary definition	Nonuser psychiatric	119	64,880	1.8 (1.5–2.2)	Reference	Reference
	Atypical or typical	198	43,550	4.6 (3.9–5.2)	1.92 (1.53–2.42)^‡	1.79 (1.42–2.27)^‡
	Atypical	97	26,345	3.7 (3.0–4.5)	1.60 (1.22–2.09)^‡	1.51 (1.14–1.99)^‡
	Typical	96	15,621	6.2 (5.0–7.5)	2.39 (1.82–3.13)^‡	2.27 (1.71–3.01)^‡
	Olanzapine	15	8425	1.8 (1.0–2.9)	1.61 (0.93–2.77)*	0 (NC)
CHD	Nonuser psychiatric	982	278,330	3.5 (3.3–3.8)	Reference	Reference
	Atypical or typical	1355	236,229	5.7 (5.4–6.1)	1.08 (1.00–1.18)*	1.16 (0.94–1.44)
	Atypical	444	86,115	5.2 (4.7–5.7)	0.94 (0.84–1.05)	0.98 (0.76–1.26)
	Typical	873	136,777	6.4 (6.0–6.8)	1.19 (1.09–1.31)^‡	1.39 (1.09–1.76)^‡
	Olanzapine	132	31,806	4.2 (3.5–4.9)	1.01 (0.84–1.21)	1.07 (0.76–1.49)
Ventricular arrhythmias	Nonuser psychiatric	500	279,243	1.8 (1.6–2.0)	Reference	Reference
	Atypical or typical	646	237,647	2.7 (2.5–2.9)	1.14 (1.01–1.28)^†	1.16 (1.02–1.31)^†
	Atypical	230	86,319	2.7 (2.3–3.0)	1.05 (0.89–1.23)	1.06 (0.90–1.26)
	Typical	382	137,982	2.8 (2.5–3.1)	1.16 (1.01–1.32)^†	1.37 (1.00–1.87)*
	Olanzapine	55	31,921	1.7 (1.3–2.2)	0.90 (0.68–1.18)	0.86 (0.65–1.14)

^∗𝑃<0.10, ^†𝑃<0.05, ^‡𝑃<0.01.
Abbreviations: aRR: adjusted relative risk; CHD: coronary heart disease; CI: confidence interval; NC: not calculated; PY: person-years; SCD: sudden cardiac death.