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

J Westman,J Hällgren,L Alfredsson,M Gissler,D Erlinge,U Ösby,S V Eriksson,M L Prieto,M A Frye,W V Bobo

doi:10.1017/s2045796017000166

Abstract

This 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. CVDs 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. People 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.

Highlights

People with schizophrenia have a 11 to 20 years shorter lifespan than people in the general population (Laursen et al 2013)
People who have schizophrenia are more likely to have more than one major risk factor for cardiovascular diseases (CVDs); namely, overweight, smoking, high blood pressure and the metabolic syndrome (Deuschle et al 2013; Gardner-Sood et al 2015; Olsson et al 2015; Gutiérrez-Rojas et al 2016)
An autopsy was performed to determine the cause of death in 5422 people who had schizophrenia (39%) and 422 113 people in the general population (19%)

Summary

Introduction

People with schizophrenia have a 11 to 20 years shorter lifespan than people in the general population (Laursen et al 2013). People who have schizophrenia are more likely to have more than one major risk factor for CVDs; namely, overweight, smoking, high blood pressure and the metabolic syndrome (Deuschle et al 2013; Gardner-Sood et al 2015; Olsson et al 2015; Gutiérrez-Rojas et al 2016). They are less likely to receive preventive care for these risk. Antipsychotic drugs, especially newer drugs, may cause major adverse cardiovascular events (Khasawneh & Shankar, 2014), but the character and magnitude of their exact effect on CVD risk are controversial (Tiihonen et al 2009; Crump et al 2013)

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Discussion

Conclusion