Comparative Risk of Cardiovascular Adverse Events among Antipsychotic Agents in Adults treated for Schizophrenia: A Systematic Review and Meta Analysis of Randomized Controlled Trials

Background: Adverse drug effects of antipsychotics differ drug to drug. Older typical antipsychotic drugs are associated with greater Extra pyramidal side effects. Among the newer atypical antipsychotic drugs, weight gain has been associated with clozapine and olanzapine. There have been numerous studies reporting increased risk of serious adverse cardiovascular events associated with antipsychotics use but none study has been done evaluating comparative risk of all antipsychotic agents in head-to-head comparison involving randomized controlled trials. Methods: Systematic review was done as per PRISMA 2020 guidelines for all outcomes of all 38 studies included for a full-text review. Meta-Analysis under random-effect model for feasible 7 outcomes were possible. PubMed, Medline, DOAJ, MDPI, Clinicaltrial.gov and Google scholar article repositories were assessed for the review. RoB-2 tool was used to assess the Risk of bias and GRADE Approach was used to grade the certainty of evidence. Results: Antipsychotic agents use showed no statistically significant results with the outcomes of hypertension, serious arrythmia, myocardial infarction, bradycardia, angina, and orthostatic hypotension. Statistically significant risk was found to be associated with antipsychotic use for the outcome of Tachycardia, Risk Ratio (RR) = 2.72, 95% Confidence Interval (CI) 1.29-5.68. Conclusion: Antipsychotic use was associated with higher incidence of Tachycardia.