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It's common to prescribe antipsychotics to older patients with dementia to control symptoms such as agitation, hallucinations and aggression. Previous studies have found that this use of the drugs may be linked to an increased risk of stroke and death from all causes.
But until now, the risk of heart attack associated with the use of antipsychotic drugs in older people with dementia had been "poorly examined," wrote study author Dr. Antoine Pariente, of Universite Bordeaux Segalen in France, and colleagues.
They looked at nearly 11,000 patients, aged 66 and older, in Quebec who were being treated with cholinesterase inhibitors for dementia and were also prescribed antipsychotics.
Within a year of starting treatment with the antipsychotics, 1.3 percent of the patients had a heart attack. Compared to those not taking antipsychotics, the risk of heart attack among those taking them was 2.19 times higher for the first 30 days, 1.62 times higher for the first 60 days, 1.36 times higher for the first 90 days, and 1.15 times higher for the first year.
"Our study results indicate that the use of [antipsychotic medications] is associated with a modest increase in the risk of [heart attack] among community-dwelling older patients with treated dementia," the researchers wrote. "The increased risk seems to be highest at the beginning of treatment and seems to decrease thereafter, with the first month of treatment accounting for the highest period of risk."
The study, which found an association between antipsychotic use and heart attack but did not prove cause-and-effect, appeared online March 26 in the Archives of Internal Medicine.
"Because [antipsychotic] use is frequent in patients with dementia ... the increased risk of [heart attack] may have a major public health effect, which highlights the need for communicating such risk and for close monitoring of patients during the first weeks of treatment," the authors concluded in a journal news release.
Further research is required to learn more about why the use of antipsychotic drugs in dementia patients may increase the risk of heart attack, Dr. Sudeep Gill and Dr. Dallas Seitz, of Queen's University in Kingston, Ontario, Canada, wrote in an accompanying editorial.
"Meanwhile, physicians should limit prescribing of antipsychotic drugs to patients with dementia and instead use other techniques when available, such as environmental and behavioral strategies, to keep these patients safe and engaged," they suggested.
While the study found an association between antipsychotic drugs and heart attack risk, it did not prove a cause-and-effect relationship.
-- Robert Preidt
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