Increased cardiovascular mortality in people with schizophrenia: a 24-year national register study

Abstract

AimsPeople who have schizophrenia die earlier from somatic diseases than do people in the general population, but information about cardiovascular deaths in people who have schizophrenia is limited. We analysed mortality in all age groups of people with schizophrenia by specific cardiovascular diseases (CVDs), focusing on five CVD diagnoses: coronary heart disease, acute myocardial infarction, cerebrovascular disease, heart failure and cardiac arrhythmias. We also compared hospital admissions for CVDs in people who had schizophrenia with hospital admissions for CVDs in the general population.MethodsThis national register study of 10 631 817 people in Sweden included 46 911 people who were admitted to the hospital for schizophrenia between 1 January 1987 and 31 December 2010. Information from national registers was used to identify people who had schizophrenia and obtain data about mortality, causes of death, medical diagnoses and hospitalisations.ResultsCVDs were the leading cause of death in people who had schizophrenia (5245 deaths), and CVDs caused more excess deaths than suicide. The mean age of CVD death was 10 years lower for people who had schizophrenia (70.5 years) than the general population (80.7 years). The mortality rate ratio (MRR) for CVDs in all people who had schizophrenia was 2.80 (95% confidence interval (CI) 2.73–2.88). In people aged 15–59 years who had schizophrenia, the MRR for CVDs was 6.16 (95% CI 5.79–6.54). In all people who had schizophrenia, the MRR for coronary heart disease was 2.83 (95% CI 2.73–2.94); acute myocardial infarction, 2.62 (95% CI 2.49–2.75); cerebrovascular disease, 2.4 (95% CI 2.25–2.55); heart failure, 3.25 (95% CI 2.94–3.6); and cardiac arrhythmias, 2.06 (95% CI 1.75–2.43). Hospital admissions for coronary heart disease were less frequent in people who had schizophrenia than in the general population (admission rate ratio, 0.88 (95% CI 0.83–0.94). In all age groups, survival after hospital admission for CVD was lower in people who had schizophrenia than in the general population.ConclusionsPeople who had schizophrenia died 10 years earlier from CVDs than did people in the general population. For all five CVD diagnoses, mortality risk was higher for those with schizophrenia than those in the general population. Survival after hospitalisation for CVDs in people who had schizophrenia was comparable with that of people in the general population who were several decades older.

Association between oxidative stress-related genes polymorphisms and metabolic abnormalities among schizophrenia patients

“…The high prevalence of overweight and metabolic abnormalities has become a major concern in schizophrenia patients [3][4][5]. This information regarding the effect of highrisk genotypes in relation to gender differences and/ or smoking status may be used to prevent overweight and metabolic abnormalities, although further investigations in larger and more diverse populations are needed to verify these findings.…”

“…These metabolic abnormalities in schizophrenia patients are strongly associated with the development of metabolic diseases including type 2 diabetes and cardiovascular diseases in comparison with general populations [3,4]. Schizophrenia patients with metabolic diseases are at an increased risk of poor adherence to treatments, an impaired cognitive function, a short life expectancy and a decline in the quality of life [4,5].…”

“…Schizophrenia patients with metabolic diseases are at an increased risk of poor adherence to treatments, an impaired cognitive function, a short life expectancy and a decline in the quality of life [4,5]. The most common cause of premature death among schizophrenia patients is cardiovascular diseases [3]. Therefore, clarification of the risk factors for obesity and/or metabolic syndrome among schizophrenia patients can contribute to the early prevention of cardiovascular diseases and of the improvement of life expectancy and quality of life.…”

Women with schizophrenia are at increased risk of breast cancer

“…Many adverse health behaviours that increase risk of cancer, such as smoking, low physical activity and poor diet, are also risk factors for cardiovascular disease—the main cause of premature mortality in people with schizophrenia 4. However, as public health interventions that are effective for reducing unhealthy behaviours in the general population often fail to reach people with schizophrenia,5 research is needed into how to improve and sustain healthy living in this group.…”

Interactions between psychiatric and physical disorders and their effects on the risks of suicide: a nested case–control study

“…− Such studies have indicated that patients with psychiatric disorders may experience worsening of cardiovascular diseases due to dysfunction of the HPA axis and autonomic nervous system, thereby leading to increased levels of cortisol, blood cholesterol (triglycerides), and blood pressure . Some studies have also indicated that psychiatric disorders are associated with platelet activation and dysregulation of the immunoinflammatory system, increasing the risk of cardio‐ and cerebrovascular diseases.…”