Risk of cerebrovascular accident associated with use of antipsychotics: population-based case-control study

Abstract

Objectives: To explore the association between use of antipsychotics and risk of cerebrovascular accident (CVA) in individuals with dementia aged 65 and older.

Design: Population-based case-control study.

Setting: UK-based electronic primary care records in the General Practice Research Database (GPRD).

Participants: Individuals with dementia aged 65 and older registered in the database between January 1, 1995, and June 22, 2007.

Measurements: Odds ratio (OR) of CVA in users versus nonusers of antipsychotics (typical or atypical) and in users of typical versus atypical antipsychotics. Multivariate analyses were performed using logistic regression models to adjust for potential confounders: demographic variables, comorbidity, and concomitant treatments.

Results: After adjusting for confounding variables, the OR of CVA associated with use of only typical antipsychotics versus no antipsychotics in individuals with dementia aged 65 and older was 1.16 (95% confidence interval (CI)=1.07-1.27) and for use of only atypical antipsychotics versus no antipsychotics was 0.62 (95% CI=0.53-0.72). In the comparison of typical versus atypical antipsychotics, the OR was 1.83 (95% CI=1.57-2.14).

Conclusion: No reasons were found to question the cerebrovascular safety of atypical antipsychotics in older adults with dementia. The typical antipsychotics appear to be associated with a higher risk of CVA, although the risk disappears after use is discontinued.