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Annual Report Year 2

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Do Some Medicines Cause Sudden Death?

Some commonly prescribed drugs-antidepressants and antibiotics among them-can affect the electrical properties of the heart. Concern has increased in recent years that these drugs actually may trigger very serious arrhythmias, often causing sudden death.

This has been a difficult area to research because many of these drugs have been used for many years and generic versions are available, which has limited funding from industry for research. The drugs continue to be used by millions of people each year, however, so the subject remains very important to the public health.

The Vanderbilt CERTs aims to tackle this issue.

Dr. Wayne Ray, Project Coordinator Sarah Meredith, and their colleagues are conducting a series of studies of certain medications and the rates of sudden cardiac death among people who take them.

Using a unique database developed and maintained by the CERTs, they first assembled a group of over 400,000 people who had nearly 1.3 million person-years of medication use.

From this group, Ray and colleagues identified nearly 1500 cases of sudden cardiac death. They confirmed the cases through careful review of the circumstances surrounding the deaths.

Then the group put the data to work.

The first of their studies, completed this year, examined the class of drugs called antipsychotics. These are medicines used to treat schizophrenia and other serious mental illnesses.

In an analysis to be published in the November 2001 issue of the Archives of General Psychiatry, the group compared the incidence of and risk factors for sudden cardiac death with the use of these drugs.

Compared with people who had never used these medicines, those who were taking high doses were more than twice as likely to die suddenly from cardiac causes (figure 5).

Further, people with severe cardiovascular disease had an even higher rate of sudden cardiac death if they were taking high doses of antipsychotic drugs-more than three times higher than among people who had never taken these medicines, in fact. People who had moderate or mild heart disease also showed proportionally higher rates of sudden cardiac death.

This study illustrates the valuable synergy that can result from interactions between the individual CERTs centers. Much of the basic work in identifying the drugs that can cause sudden death has come from studies by Drs. Raymond Woosley, David Flockhart, and their colleagues at the Arizona center. This center has a systematic program for identifying drugs, including those in development, that can affect the electrical properties of the heart.

Dr. Ray and colleagues will continue to leverage the findings from the Arizona program, next studying the risk of sudden death with antidepressant and antibiotic drugs.

Their findings could, in turn, feed into an overall CERTs initiative to develop a core curriculum for caregivers (see On the Horizon). This is an example of one of the many synergies that the CERTs organization makes possible.

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