Abstract
Individuals with obsessive-compulsive disorder (OCD) may have an increased risk of cardiovascular disease (CVD), but evidence for specific types of CVD is limited. This population-based, sibling-controlled cohort study investigated the risk of specific CVD in individuals with OCD. Linking data from various Swedish population-based registers, we explored the risk of a range of CVD in a cohort of individuals diagnosed with OCD between 1973 and 2013 (n = 33,561), compared to matched (1:10) unaffected individuals (n = 335,610). Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using conditional Cox proportional hazards regression models, adjusting for history of somatic diseases. To control for familial confounders, we analyzed 23,263 clusters of full siblings discordant for OCD. Individuals with psychiatric comorbidities were systematically excluded to assess the impact of these comorbidities. Over an average follow-up time of 27 years, OCD was associated with an increased risk of a broad range of CVD (adjusted HR [aHR] for any CVD = 1.25 [95% confidence interval [CI], 1.22–1.29]). These associations were strongest for the subtypes venous thrombo-embolism (aHR = 1.48 [95% CI, 1.38–1.58]) and heart failure (aHR = 1.37 [95% CI, 1.28–1.46]). When comparing OCD-exposed individuals with their non-exposed full siblings, results were largely similar. Exclusion of several groups of psychiatric comorbidities resulted in comparable results, albeit attenuated. Individuals with OCD have a moderately increased risk of CVD-related morbidity, independent from history of somatic diseases, familial confounders, and psychiatric comorbidities. The time may be ripe for the development and evaluation of lifestyle interventions to help reduce the risk of cardiovascular morbidity in OCD.
Highlights
Obsessive-compulsive disorder (OCD) is an impairing psychiatric condition with a lifetime prevalence of about 2% (Ruscio et al, 2010)
Frequencies and proportions of each subtype of Cardiovascular diseases (CVD) in cases and con trols are shown in Supplemental Table 4
After controlling for history of severe somatic diseases, the cohort of individuals with OCD had a 25% increased risk of any CVD, compared to the matched controls
Summary
Obsessive-compulsive disorder (OCD) is an impairing psychiatric condition with a lifetime prevalence of about 2% (Ruscio et al, 2010). Individuals with psychiatric disorders are a group of high risk of CVD, with increased rates of both CVD-related morbidity and mortality (Harris and Barraclough, 1998; Lawrence et al, 2013; Momen et al, 2020; Roest et al, 2010; Song et al, 2019; Tiihonen et al, 2016), but OCD has rarely been studied separately from broader groups of anxiety or ‘neurotic’ disorders. This is important as the risks of CVD following a diagnosis of a psychiatric disorder vary considerably between disorders, and these risks vary by specific CVD (Momen et al, 2020).
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