Patients on Antipsychotics at High Risk for Cardiovascular Issues, Study Finds

Antipsychotics present a known risk for major side effects. A new study suggests that certain antipsychotics may present a greater risk for cardiovascular disease than others.


Researchers from Buenos Aires Argentina explore the risk for cardiovascular disease in people prescribed antipsychotic drugs. Their study finds that patients who started on intermediate and high-risk antipsychotics were at significantly higher risk of experiencing a cardiovascular event than those who began with a lower risk medication.

Individuals diagnosed with schizophrenia often experience numerous comorbid conditions including (among others) obesity and type 2 diabetes mellitus which can increase the rate of cardiovascular disease (CVD) and mortality within this population. Moreover, cardiovascular disease has been implicated in the widening mortality gap between persons with schizophrenia or bipolar diagnosis and the general population.

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Given the high incidence of CVD in persons prescribed antipsychotics, as well as weight gain and metabolic abnormalities, the present study aimed to evaluate the effect of various antipsychotic medications. The different drugs were classified as either low, intermediate, or high risk for cardiovascular events. The researchers conducted a retrospective cohort study of 1,008 patients receiving antipsychotic medications for the first time. The participants were and assessed outcome measures at two and five years.

Baseline characteristics collected included age, sex, year of index date, psychiatric diagnoses, and baseline characteristics regarding prior cardiovascular events. Risk factors and markers for CVD were also examined along with chronic pulmonary obstructive disease, heart failure, chronic renal failure, malignancy, tobacco and alcohol use, number of hospitalizations and number of suicide attempts.

The primary outcome of interest was the composite of acute myocardial infarction, acute coronary syndrome, ischemic stroke, peripheral artery disease, or a new revascularization procedure. The composite secondary outcomes included time to the composite of the primary outcome plus all-cause mortality as well as onset of type-2 diabetes mellitus

The different antipsychotic drugs were divided into three categories; low risk, intermediate risk, and high risk. The low-risk class was composed of haloperidol, aripiprazole, ziprasidone, trifluoperazine, and levomepromazine. The middle category included quetiapine and risperidone. The high-risk group included thioridazine, olanzapine, and clozapine. Patients who were on two or more of the antipsychotics were placed in the high-risk group.

Of the 1,008 patients in the study, 223 were in the low risk group, 465 were in the intermediate group, and 320 were in the high-risk antipsychotic group. At baseline, most persons prescribed antipsychotics had a diagnosis of dementia, followed by depression, bipolar disorder, and schizophrenia. Most patients were treated with low doses of antipsychotic drugs.

Those on low-risk antipsychotics had higher CVD comorbidity at baseline. Significantly more in the high-risk group compared to the low-risk group developed obesity with AP treatment. 15.9% and 6.7% of the high risk and intermediate risk groups developed type 2 diabetes. No significant differences were found for the number of hospitalizations or suicide attempts between high, intermediate, and low-risk medication groups.

Overall, 19.6% of the participants experienced a CV event.  Those in the low-risk group had fewer events during follow up period. The intermediate group was at 2.57 times the hazard of the low-risk group. Within the high-risk group, primary composite outcomes were 2.82 times the hazard of the low-risk group. No apparent differences between groups on all-cause mortality were observed. Only those on high-risk medication presented with significantly more type 2 diabetes incidents when compared to the low-risk group.

Researchers found an increased risk of significant CV outcome presentations among patients who started antipsychotic mediation classified as either intermediate or high risk.



Szmulewicz, A. G., Angriman, F., Pedroso, F. E., Vazquez, C., & Martino, D. J. (2017). Long-Term Antipsychotic Use and Major Cardiovascular Events: A Retrospective Cohort Study. The Journal of clinical psychiatry. (Link)

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Bernalyn Ruiz
MIA Research News Team: Bernalyn Ruiz-Yu is a Postdoctoral Fellow in the Department of Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles. She completed her Ph.D. in Counseling Psychology from the University of Massachusetts Boston. Dr. Ruiz-Yu has diverse clinical expertise working with individuals, families, children, and groups with a special focus on youth at risk for psychosis. Her research focuses on adolescent serious mental illness, psychosis, stigma, and the use of sport and physical activity in our mental health treatments.


  1. Well, this should not be a surprise to anyone. This has been known by anyone not in denial for well over a decade now. Of course, facts never have had much impact on psychiatric practice – they prefer to blame early death on the “poor life habits” of their charges.

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  2. I read an article in NAMI’s magazine discussing how the “severely mentally ill” died young because of their illnesses. The person who wrote the article was a meds-compliant grateful consumer. She was probably genuinely ignorant why she had heart problems. It couldn’t have been the “medicines” or her doctor would have warned her. Right?

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  3. I sent This in to Baroness Sheila Hollins when she was President of the BMA:-


    IN 2005 the Drug Mellaril (thioridazine) was withdrawn in the UK on account of its heart rythm effects. Mellaril was replaced with drugs like Seroquel (quietiapine).

    Seroquel has a ‘Black Box’ warning in America, and it is banned in the American military on account of its lethal heart rythm effect (it was killing young fit men):…/

    Most of the UK consumers are overweight with high blood pressure and high cholesterol so when they die the cause of death (even if investigated) is likely to be indistinguishable.

    I don’t think “Medication Reviews” in the UK are investigating for heart rythm problems – as they should be; and it’s also difficult for consumers to connect up this type of problem or to assert themselves.

    Also, in 2005 Seroquel was on patent and cost about 50 times more than Mellaril.

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  4. I had a heart arrhythmia for the last few years. Went off my psych drugs and it’s milder. Healing perhaps? I am mum about my “noncompliance” so no one but me links cause and effect. Effortlessly lost 35 pounds of the 175 pounds the drugs packed on over the years. Everyone wonders what my secret is.

    Maybe make a commercial selling my weight loss secret. Quit taking psych drugs! That would go over like a lead balloon.

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