Most of the randomized controlled trials (RCTs) on antipsychotics (APs) have efficacy as their primary endpoint, leading to a lack of evidence on long-term metabolic effects of APs. The aim of the present meta-analysis is to compare different APs for the long-term modification of risk of major adverse cardiovascular events (MACE) and related mortality, in patients with schizophrenia and bipolar disorder. All RCTs found on Medline/Embase of at least 52 weeks up to 19 December 2017, enrolling patients with bipolar disorder or schizophrenia and comparing an AP with another AP or placebo were included. The primary outcome of this analysis was the association of APs with the incidence of cardiovascular death, myocardial infarction (MI), and stroke. 3013 studies were screened, 92 met the selection criteria. MI, stroke and cardiovascular death were reported in 11, 6 and 24 studies, respectively. No significant difference was observed with respect to MI and Stroke; a significantly higher cardiovascular mortality was observed for sertindole when compared to risperidone (Mantel-Haenszel Odds Ratio: 2.56, 95% CI: 1.33 - 5). Long-term cardiovascular effects of APs deserve to be studied more extensively. The request by regulatory authorities of cardiovascular safety data from specifically designed trials would be useful.

中文翻译：

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抗精神病药物的长期代谢和心血管作用。随机对照试验的荟萃分析

大多数关于抗精神病药 (AP) 的随机对照试验 (RCT) 都将疗效作为其主要终点，导致缺乏关于 AP 长期代谢影响的证据。本荟萃分析的目的是比较不同 AP 对精神分裂症和双相情感障碍患者主要不良心血管事件 (MACE) 和相关死亡率风险的长期改变。截至 2017 年 12 月 19 日，在 Medline/Embase 上发现的所有 RCT 至少 52 周，纳入双相情感障碍或精神分裂症患者并将 AP 与另一种 AP 或安慰剂进行比较。该分析的主要结果是 AP 与心血管死亡、心肌梗塞 (MI) 和中风发生率的关联。筛选了 3013 项研究，92 项符合选择标准。米，分别有 11、6 和 24 项研究报告了卒中和心血管死亡。在 MI 和中风方面没有观察到显着差异；与利培酮相比，舍吲哚的心血管死亡率显着更高（Mantel-Haenszel Odds Ratio：2.56，95% CI：1.33 - 5）。AP 的长期心血管影响值得更广泛地研究。监管机构要求从专门设计的试验中获得心血管安全性数据将是有用的。AP 的长期心血管影响值得更广泛地研究。监管机构要求从专门设计的试验中获得心血管安全性数据将是有用的。AP 的长期心血管影响值得更广泛地研究。监管机构要求从专门设计的试验中获得心血管安全性数据将是有用的。