Abstract
ObjectiveDespite high mortality associated with serious mental illness, risk of acute myocardial infarction (AMI) remains unclear, especially for patients with bipolar disorder. The main objective was to investigate the relative risk of AMI associated with schizophrenia and bipolar disorders in a national sample.MethodUsing nationwide administrative data, an 11-year historic cohort study was assembled, comprised of cases aged 18 and above who had received a diagnosis of schizophrenia or bipolar disorder, compared to a random sample of all other adults excluding those with diagnoses of serious mental illness. Incident AMI as a primary diagnosis was ascertained. Hazard ratios stratified by age and gender were calculated and Cox regression models were used to adjust for other covariates.ResultsA total of 70,225 people with schizophrenia or bipolar disorder and 207,592 people without serious mental illness were compared. Hazard ratios in men adjusted for age, income and urbanization were 1.15 (95% CI 1.01~1.32) for schizophrenia and 1.37 (1.08~1.73)for bipolar disorder, and in women, 1.85 (1.58~2.18) and 1.88(1.47~2.41) respectively. Further adjustment for treated hypertension, diabetes and hyperlipidaemia attenuated the hazard ratio for men with schizophrenia but not the other comparison groups. Hazard ratios were significantly stronger in women than men and were stronger in younger compared to older age groups for both disorders; however, gender modification was only significant in people with schizophrenia, and age modification only significant in people with bipolar disorder.ConclusionsIn this large national sample, schizophrenia and bipolar disorder were associated with raised risk of AMI in women and in the younger age groups although showed differences in potential confounding and modifying factors.
Highlights
People with serious mental illness experience significant functional decline and premature mortality [1]
Hazard ratios in men adjusted for age, income and urbanization were 1.15 for schizophrenia and 1.37 (1.08~1.73)for bipolar disorder, and in women, 1.85 (1.58~2.18) and 1.88(1.47~2.41) respectively
Mental Illness and Acute Myocardial Infarction Risk regulations of Bureau of National Health Insurance (BNHI) and National Health Research Institutes (NHRI), and an agreement must be signed by the applicant and his/her supervisor upon application submission
Summary
People with serious mental illness experience significant functional decline and premature mortality [1]. Several studies have suggested that this may be explained by a higher prevalence of physical comorbidities[1,3,7,8].The prevalence of cardiovascular disease(CVD) isparticularly high [9,10,11,12], and CVD has rapidly becomethe leading cause of death in people with serious mental illness [13,14]. Factors underlying these associations are likely to include socio-economic deprivation,and worse risk profiles including smoking, lack of exercise and obesity [15]. These factors are alsoassociated with levels of urbanization (influenced by theincrease in the consumption of protein and fat, the decrease in energy expenditures[19]),and with psychotropic agents–especially antipsychotics, which may induce glucose or metabolic dysfunctions through direct molecular effects or increased abdominal adiposity[20,21,22,23]
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