Background People with schizophrenia/schizoaffective disorder (schizophrenia) die early, largely due to cardiovascular-related mortality. Antipsychotics are associated with lower mortality. We aimed to explore whether antipsychotic use can reduce discontinuation of medications for cardiovascular risk factors and diseases (“cardiometacolic drugs”), using a within-study design controlling for subject-related factors. Methods Persons diagnosed with schizophrenia between 1972 and 2014, aged <65 years at cohort entry were identified in Finnish national databases. Four subcohorts were formed based on cardiometabolic drug use during the follow-up period, 1996–2017, namely statin (n = 14,047), antidiabetic (n = 13,070), antihypertensive (n = 17,227), and beta-blocker (n = 21,464) users. To control for subject-related factors, including likelihood of adherence as a trait characteristic, we conducted a within-subject study comparing the risk of discontinuation of each cardiometabolic drug during periods on vs off antipsychotics within each subject. We also accounted for number of psychiatric and nonpsychiatric visits in sensitivity analyses. Results In 52,607 subjects with schizophrenia, any antipsychotic use vs nonuse was associated with decreased discontinuation risk of antidiabetics (adjusted hazard ratio [aHR] = 0.56, 95% confidence interval [CI] = 0.47–0.66), statins (aHR = 0.61, 95%CI = 0.53–0.70), antihypertensives (aHR = 0.63, 95%CI = 0.56–0.71), and beta-blockers (aHR = 0.79, 95%CI = 0.73–0.87). Antipsychotics ranking best for discontinuation of all cardiometabolic drug categories were clozapine (aHR range = 0.34–0.55), followed by olanzapine (aHR = 0.43–0.71). For statins, aHRs ranged from aHR = 0.30 (95%CI = 0.09–0.98) (flupentixol-long-acting injectable (LAI) to aHR = 0.71 (95%CI = 0.52–0.97) (risperidone-LAI), for anti-diabetic medications from aHR = 0.37 (95%CI = 0.28–0.50) (clozapine) to aHR = 0.70 (95%CI = 0.53–0.92) (quetiapine), for antihypertensives from aHR = 0.14 (95%CI = 0.04–0.46) (paliperidone-LAI) to aHR = 0.69 (95%CI = 0.54–0.88) (perphenazine), for beta-blockers from aHR = 0.55 (95%CI = 0.48–0.63) (clozapine) to aHR = 0.76 (95%CI = 0.59–0.99) (perphenazine-LAI). The decreased risk of discontinuation associated with antipsychotic use somewhat varied between age strata. Sensitivity analyses confirmed main findings. Discussion In this national database within-subject design study, current antipsychotic use was associated with substantially decreased risk of discontinuation of statins, anti-diabetics, antihypertensives, and beta-blockers, which might explain reduced cardiovascular mortality observed with antipsychotics in people with schizophrenia.

中文翻译：

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抗精神病药的使用与精神分裂症患者对心脏代谢药物的更高依从性有关：一项全国性的受试者内设计研究结果

背景 精神分裂症/分裂情感障碍（精神分裂症）患者过早死亡，主要是由于心血管相关的死亡率。抗精神病药与较低的死亡率有关。我们的目的是使用控制受试者相关因素的研究内设计来探索抗精神病药物的使用是否可以减少心血管危险因素和疾病药物（“心脏代谢药物”）的停药。方法 在芬兰国家数据库中确定了 1972 年至 2014 年间被诊断患有精神分裂症、年龄小于 65 岁的队列进入者。在 1996 年至 2017 年的随访期间，根据心脏代谢药物的使用情况形成了四个亚组，即他汀类药物（n = 14,047）、抗糖尿病药物（n = 13,070）、抗高血压药物（n = 17,227）和β受体阻滞剂（n = 21,464） ) 用户。为了控制与主题相关的因素，包括将依从性作为特征特征的可能性，我们进行了一项受试者内研究，比较了每个受试者在服用抗精神病药物期间停用每种心脏代谢药物的风险。我们还在敏感性分析中考虑了精神科和非精神科就诊的次数。结果 在 52,607 名精神分裂症患者中，任何抗精神病药物的使用与不使用都与降低抗糖尿病药物停药风险相关（调整后的风险比 [aHR] = 0.56, 95% 置信区间 [CI] = 0.47–0.66），他汀类药物（aHR = 0.61, 95 %CI = 0.53–0.70)、抗高血压药 (aHR = 0.63, 95%CI = 0.56–0.71) 和 β 受体阻滞剂 (aHR = 0.79, 95%CI = 0.73–0.87)。最适合停用所有心脏代谢药物类别的抗精神病药物是氯氮平（aHR 范围 = 0.34-0.55），其次是奥氮平（aHR = 0.43-0.71）。