Schizophrenia and increased risks of cardiovascular disease

doi:10.1016/j.ahj.2005.02.007

American Heart Journal

Volume 150, Issue 6, December 2005, Pages 1115-1121

https://doi.org/10.1016/j.ahj.2005.02.007 Get rights and content

Objective

The aim of the study is to review the absolute and relative impacts of the major causes for premature mortality among patients with schizophrenia.

Data sources

We reviewed published articles on causes of mortality in the general population as well as among patients with schizophrenia.

Study selection

We selected articles which published total and cause-specific mortality rates.

Data extraction

We reviewed the causes of mortality and their risk factors.

Data synthesis

The average life expectancy of the general population is 76 years (72 years in men, 80 years in women), whereas the corresponding figure is 61 years (57 years in men, 65 years in women) among patients with schizophrenia. Thus, patients with schizophrenia have approximately a 20% reduced life expectancy compared with the general population. Although patients with schizophrenia are 10 to 20 times more likely than the general population to commit suicide, more than two thirds of patients with schizophrenia, compared with approximately one-half in the general population, die of coronary heart disease (CHD). The chief risk factors for this excess risk of death are cigarette smoking, obesity leading to dyslipidemia, insulin resistance and diabetes, and hypertension.

Conclusions

The chief cause of excess premature mortality among patients with schizophrenia is CHD, caused mainly by their adverse risk factor profile. Because patients with schizophrenia have less access to medical care, consume less medical care, and are less compliant with their regimens, the choice of antipsychotic drug regimens that do not further adversely affect their risk factor for CHD is a major clinical and public health challenge among patients with schizophrenia.

Section snippets

Mortality among patients with schizophrenia

Whereas the average life expectancy in the general population of the United States is approximately 76 years (72 years in men and 80 years in women),¹ that among patients with schizophrenia is approximately 20% shorter or 61 years (57 years in men and 65 years in women).3, 4 This significantly lower life expectancy for patients with schizophrenia is caused primarily by CHD and also by other etiologies, principally suicide.⁵ With respect to suicide, approximately 50% of patients with

Major risk factors for CHD in the general population and among patients with schizophrenia

Major risk factors for CHD, including cigarette smoking, blood cholesterol, hypertension, obesity, and diabetes mellitus, are more common among patients with schizophrenia than in the general population. In the general population, patients often prefer prescription of pills to proscription of harmful lifestyles. Among patients with schizophrenia, compliance with pill taking is difficult to achieve, including their antipsychotic drug regimen. Thus, emphasis on the prescription of antipsychotic

Discussion

Among patients with schizophrenia, there is an enormous clinical and public health burden of CHD which is chiefly responsible for their reduced life expectancy. Although greater emphasis on treatment including favorable modification of risk factors is important, efforts aimed at the primary prevention of unfavorable risk factors assume even greater importance in patients with schizophrenia. The treatment and prevention strategies should include encouraging healthy lifestyles, smoking cessation,

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A subset of individuals with schizophrenia (SZ) are thought to have a microvascular component to their illness with studies demonstrating alterations in retinal superficial, deep, and choroidal microvasculature networks. However, the direction and location of these alterations have differed across studies. In a recent study, we reported that individuals with SZ demonstrated lower superficial layer perfusion density than a healthy control (HC) group. The current study investigated characteristics of the deep vascular layer in SZ. We included 28 individuals with a diagnosis of SZ or schizoaffective disorder, and 37 HCs. Optical coherence tomography angiography (OCTA) data was collected to measure deep retinal layer perfusion density, skeletonized vessel density, vessel diameter index, and fractal dimension. We conducted between-group comparisons to examine differences in these OCTA variables between SZ and HC groups. A trend analysis was conducted to determine if differences reflected a linear trend according to age and illness length, and Spearman correlations were conducted to determine associations between deep and superficial layer density. Individuals with SZ demonstrated significantly lower bilateral perfusion density and vessel diameter index, as well as lower left eye skeletonized vessel density and fractal dimension. There was a significant linear trend in the data indicating that individuals with chronic SZ demonstrated the lowest OCTA values, followed by individuals within two years of their first episode of psychosis who did not differ from older controls, followed by younger controls, who demonstrated the highest values in at least one eye. Lower density values in the deep retinal layer were also significantly associated with lower density values in the superficial layer. Overall, results suggest that microvascular alterations are present in multiple retinal layers in SZ and that they may be useful visual system biomarkers of neurovascular changes in the disorder.
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Curriculum in CardiologySchizophrenia and increased risks of cardiovascular disease

Objective

Data sources

Study selection

Data extraction

Data synthesis

Conclusions

Section snippets

Mortality among patients with schizophrenia

Major risk factors for CHD in the general population and among patients with schizophrenia

Discussion

Lancet

Psychiatry Res

Comp Psychiatry

Prostaglandins Leukot Essent Fatty Acids

Eur Neuropsychopharmacol

Biol Psychiatry

Psychosomatics

J Pediatr

Biol Psychiatry

Prog Neuropsychopharmacol Biol Psychiatry

Increasing burden of cardiovascular disease: current knowledge and future directions for research on risk factors

Circulation

Clinical and research challenges in risk factors for cardiovascular diseases

Eur Heart J

Mortality in a cohort of patients with schizophrenia: a record linkage study

Can J Psychiatry

Excess mortality of mental disorder

Br J Psychiatry

Excessive morbidity and mortality in schizophrenia

Suicide in schizophrenia: risk factors and clozapine treatment

J Clin Psychiatry

Epidemiology in medicine

Causes of excess mortality of schizophrenia

Br J Psychiatry

Mental disorders and use of cardiovascular procedures after myocardial infarction

JAMA

Cardiovascular procedures in patients with mental disorders

JAMA

The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today

J Natl Cancer Inst

Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia

Am J Psychiatry

Ziprasidone's benefits versus olanzapine on weight and insulin resistance

Cholesterol lowering with statin drugs, risk of stroke and total mortality

JAMA

The Lipid Treatment Assessment Project (L-Tap): a multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid lowering therapy and achieving low density lipoprotein cholesterol goals

Arch Intern Med

The treatment of unrelated disorders in patients with chronic medical diseases

N Engl J Med

Novel antipsychotics and severe hyperlipidemia

J Clin Psychopharmacol

Elevated levels of insulin, leptin and blood lipids in olanzapine-treated patients with schizophrenia or related psychoses

J Clin Psychiatry

The association of medical comorbidity in schizophrenia with poor physical and mental health

J Nerv Ment Dis

Curriculum in Cardiology
Schizophrenia and increased risks of cardiovascular disease