Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-13T02:12:54.159Z Has data issue: false hasContentIssue false
  • English
  • Français

Cardiovascular morbidity, mortality and pharmacotherapy in patients with schizophrenia

Published online by Cambridge University Press:  12 March 2012

M. Lahti ,
J. Tiihonen ,
H. Wildgust ,
M. Beary ,
R. Hodgson ,
E. Kajantie ,
C. Osmond ,
K. Räikkönen  and
J. Eriksson
M. Lahti*
Affiliation:
Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
J. Tiihonen
Affiliation:
Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden Department of Mental Health and Alcohol Research, National Institute for Health and Welfare, Helsinki, Finland
H. Wildgust
Affiliation:
Hiram Consulting, Ackworth, West Yorkshire, UK
M. Beary
Affiliation:
Priority Hospital North London, London, UK
R. Hodgson
Affiliation:
Lyme Brook Centre, Newcastle-under-Lyme, Staffordshire, UK
E. Kajantie
Affiliation:
Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland Helsinki University Central Hospital, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
C. Osmond
Affiliation:
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
K. Räikkönen
Affiliation:
Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
J. Eriksson
Affiliation:
Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland Helsinki University Central Hospital, Unit of General Practice, Helsinki, Finland Folkhälsan Research Centre, Helsinki, Finland Vasa Central Hospital, Vasa, Finland Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
*
*Address for correspondence: M. Lahti, M.A., Institute of Behavioural Sciences, University of Helsinki, 00014 Helsinki, Finland. (Email: marius.lahti@helsinki.fi)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Patients with schizophrenia have excess cardiovascular morbidity and mortality. Previous studies suggest that this may be partly due to inadequate somatic treatment and care, such as non-optimal use of lipid-lowering and antihypertensive pharmacotherapy, but longitudinal studies on such aetiological pathways are scarce.

Method

We investigated the use of lipid-lowering and antihypertensive pharmacotherapy, and the risk of hospitalization for and death from coronary heart disease and stroke among patients with schizophrenia in a birth cohort of 12 939 subjects (Helsinki Birth Cohort Study). This cohort was followed for over 30 adult years by using national databases on cardio- and cerebrovascular hospitalizations and mortality and on reimbursement entitlements and use of drugs for treatment of hypertension, dyslipidaemia, coronary heart disease and diabetes.

Results

Individuals with schizophrenia had a higher risk of hospitalization for coronary heart disease [hazard ratio (HR) 1.65, 95% confidence interval (CI) 1.03–2.57], and mortality from this disease was markedly higher (HR 2.92, 95% CI 1.70–5.00), particularly among women (p=0.001 for women, p=0.008 for men). Women with schizophrenia had also marginally increased stroke mortality (p=0.06). However, patients with schizophrenia used less lipid-lowering (odds ratio 0.47, 95% CI 0.27–0.80) and antihypertensive drug treatment (HR 0.37, 95% CI 0.22–0.61).

Conclusions

In this longitudinal study, coronary heart disease morbidity was increased and coronary heart disease mortality markedly increased in patients, especially in women with schizophrenia. These patients nevertheless received less antihypertensive and lipid-lowering treatment.

Keywords

Cardiovascular diseaselongitudinal studiesmorbiditymortalitypharmacotherapypsychosis
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 11 , November 2012 , pp. 2275 - 2285
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barker, DJ, Forsén, T, Eriksson, JG, Osmond, C (2002). Growth and living conditions in childhood and hypertension in adult life: a longitudinal study. Journal of Hypertension 20, 1951–1956.CrossRefGoogle ScholarPubMed
Basu, D, Aggarwal, M (2009). Mortality in patients with schizophrenia. Lancet 374, 1591.CrossRefGoogle ScholarPubMed
Brown, S, Kim, M, Mitchell, C, Inskip, H (2010). Twenty-five year mortality of a community cohort with schizophrenia. British Journal of Psychiatry 196, 116–121.CrossRefGoogle ScholarPubMed
Brown, S, Mitchell, C (2011). Predictors of death from natural causes in schizophrenia: 10-year follow-up of a community cohort. Social Psychiatry and Psychiatric Epidemiology. Published online 11 May 2011. doi:10.1007/s00127-011-0392-6.Google ScholarPubMed
Chang, CK, Hayes, RD, Perera, G, Broadbent, MT, Fernandes, AC, Lee, WE, Hotopf, M, Stewart, R (2011). Life expectancy at birth for people with serious mental illness and other major disorders from a secondary mental health care case register in London. PLoS ONE 6, e19590. doi:10.1371/journal.pone.0019590.CrossRefGoogle Scholar
Cholesterol Treatment Trialists' (CTT) Collaborators, Kearney, PM, Blackwell, L, Collins, R, Keech, A, Simes, J, Peto, R, Armitage, J, Baigent, C (2008). Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 371, 117–125.Google Scholar
De Hert, M, Cohen, D, Bobes, J, Cetkovich-Bakmas, M, Leucht, S, Ndetei, DM, Newcomer, JW, Uwakwe, R, Asai, I, Möller, HJ, Gautam, S, Detraux, J, Correll, CU (2011 a). Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry 10, 138–151.CrossRefGoogle ScholarPubMed
De Hert, M, Correll, CU, Bobes, J, Cetkovich-Bakmas, M, Cohen, D, Asai, I, Detraux, J, Gautam, S, Möller, HJ, Ndetei, DM, Newcomer, JW, Uwakwe, R, Leucht, S (2011 b). Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 10, 52–77.CrossRefGoogle ScholarPubMed
De Hert, M, Kalnicka, D, van Winkel, R, Wampers, M, Hanssens, L, Van Eyck, D, Scheen, A, Peuskens, J (2006). Treatment with rosuvastatin for severe dyslipidaemia in patients with schizophrenia and schizoaffective disorder. Journal of Clinical Psychiatry 67, 1889–1896.CrossRefGoogle ScholarPubMed
Druss, BG, Bradford, DW, Rosenheck, RA, Radford, MJ, Krumholz, HM (2000). Mental disorders and use of cardiovascular procedures after myocardial infarction. Journal of the American Medical Association 283, 506–511.CrossRefGoogle ScholarPubMed
Druss, BG, Bradford, WD, Rosenheck, RA, Radford, MJ, Krumholz, HM (2001). Quality of medical care and excess mortality in older patients with mental disorders. Archives of General Psychiatry 58, 565–572.CrossRefGoogle ScholarPubMed
Flegal, KM, Graubard, BI, Williamson, DF, Gail, MH (2007). Cause-specific excess deaths associated with underweight, overweight, and obesity. Journal of the American Medical Association 298, 2028–2037.CrossRefGoogle ScholarPubMed
Forsén, T, Eriksson, J, Tuomilehto, J, Reunanen, A, Osmond, C, Barker, D (2000). The fetal and childhood growth of persons who develop type 2 diabetes. Annals of Internal Medicine 133, 176–182.CrossRefGoogle ScholarPubMed
Gueyffier, F, Boutitie, F, Boissel, JP, Pocock, S, Coope, J, Cutler, J, Ekbom, T, Fagard, R, Friedman, L, Perry, M, Prineas, R, Schron, E (1997). Effect of antihypertensive drug treatment on cardiovascular outcomes in women and men. A meta-analysis of individual patient data from randomized, controlled trials. The INDANA Investigators. Annals of Internal Medicine 126, 761–767.CrossRefGoogle Scholar
Hennekens, CH, Hennekens, AR, Hollar, D, Casey, DE (2005). Schizophrenia and increased risks of cardiovascular disease. American Heart Journal 150, 1115–1121.CrossRefGoogle ScholarPubMed
Hippisley-Cox, J, Parker, C, Coupland, C, Vinogradova, Y (2007). Inequalities in the primary care of patients with coronary heart disease and serious mental health problems: a cross-sectional study. Heart 93, 1256–1262.CrossRefGoogle ScholarPubMed
Jemal, A, Siegel, R, Ward, E, Hao, Y, Xu, J, Murray, T, Thun, MJ (2008). Cancer statistics (2008). CA: a Cancer Journal for Clinicians 58, 71–96.Google Scholar
Kelly, DL, McMahon, RP, Wehring, HJ, Liu, F, Mackowick, KM, Boggs, DL, Warren, KR, Feldman, S, Shim, J, Love, RC, Dixon, L (2011). Cigarette smoking and mortality risk in people with schizophrenia. Schizophrenia Bulletin 37, 832–838.CrossRefGoogle ScholarPubMed
Keskimäki, I, Aro, S (1991). The accuracy of data on diagnoses, procedures and accidents in the Finnish Hospital Discharge Register. International Journal of Health Services 2, 15–21.Google Scholar
Kieseppä, T, Partonen, T, Kaprio, J, Lönnqvist, J (2000). Accuracy of register- and record based bipolar I disorder diagnoses in Finland – a study of twins. Acta Neuropsychiatrica 12, 106–109.CrossRefGoogle ScholarPubMed
Kilbourne, AM, Morden, NE, Austin, K, Ilgen, M, McCarthy, JF, Dalack, G, Blow, FC (2009). Excess heart-disease-related mortality in a national study of patients with mental disorders: identifying modifiable risk factors. General Hospital Psychiatry 31, 555–563.CrossRefGoogle Scholar
Kisely, S, Campbell, LA, Wang, Y (2009). Treatment of ischaemic heart disease and stroke in individuals with psychosis under universal healthcare. British Journal of Psychiatry 195, 545–550.CrossRefGoogle ScholarPubMed
Kisely, S, Smith, M, Lawrence, D, Cox, M, Campbell, LA, Maaten, S (2007). Inequitable access for mentally ill patients to some medically necessary procedures. Canadian Journal of Psychiatry 176, 779–784.Google ScholarPubMed
Lahti, RA, Penttilä, A (2001). The validity of death certificates: routine validation of death certification and its effects on mortality statistics. Forensic Science International 115, 15–32.CrossRefGoogle ScholarPubMed
Laursen, TM, Munk-Olsen, T, Agerbo, E, Gasse, C, Mortensen, PB (2009). Somatic hospital contacts, invasive cardiac procedures, and mortality from heart disease in patients with severe mental disorder. Archives of General Psychiatry 66, 713–720.CrossRefGoogle ScholarPubMed
Leppälä, JM, Virtamo, J, Heinonen, OP (1999). Validation of stroke diagnosis in the National Hospital Discharge Register and the Register of Causes of Death in Finland. European Journal of Epidemiology 15, 155–160.CrossRefGoogle ScholarPubMed
Lewington, S, Clarke, R, Qizilbash, N, Peto, R, Collins, R (2002). Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360, 1903–1913.Google ScholarPubMed
Mähönen, M, Salomaa, V, Brommels, M, Molarius, A, Miettinen, H, Pyörälä, K, Tuomilehto, J, Arstila, M, Kaarsalo, E, Ketonen, M, Kuulasmaa, K, Lehto, S, Mustaniemi, H, Niemelä, M, Palomäki, P, Torppa, J, Vuorenmaa, T (1997). The validity of hospital discharge register data on coronary heart disease in Finland. European Journal of Epidemiology 13, 403–415.CrossRefGoogle ScholarPubMed
Mäkikyrö, T, Isohanni, M, Moring, J, Hakko, H, Hovatta, I, Lönnqvist, J (1998). Accuracy of register-based schizophrenia diagnoses in a genetic study. European Psychiatry 13, 57–62.CrossRefGoogle Scholar
McEvoy, JP, Meyer, JM, Goff, DC, Nasrallah, HA, Davis, SM, Sullivan, L, Meltzer, HY, Hsiao, J, Scott Stroup, T, Lieberman, JA (2005). Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophrenia Research 80, 19–32.CrossRefGoogle ScholarPubMed
Mitchell, AJ, Delaffon, V, Vancampfort, D, Correll, CU, De Hert, M (2012). Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices. Psychological Medicine 42, 125–147.CrossRefGoogle ScholarPubMed
Mitchell, AJ, Lawrence, D (2011). Revascularisation and mortality rates following acute coronary syndromes in people with severe mental illness: comparative meta-analysis. British Journal of Psychiatry 198, 434–441.CrossRefGoogle ScholarPubMed
Mitchell, AJ, Lord, O (2010). Do deficits in cardiac care influence high mortality rates in schizophrenia? A systematic review and pooled analysis. Journal of Psychopharmacology 24, 69–80.CrossRefGoogle ScholarPubMed
Morrato, EH, Druss, B, Hartung, DM, Valuck, RJ, Allen, R, Canpagna, E, Newcomer, JW (2010). Metabolic testing rates in 3 state Medicaid programs after FDA warnings and ADA/APA recommendations for second-generation antipsychotic drugs. Archives of General Psychiatry 67, 17–24.CrossRefGoogle ScholarPubMed
Nasrallah, HA, Meyer, JM, Goff, DC, McEvoy, JP, Davis, SM, Stroup, TS, Lieberman, JA (2006). Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline. Schizophrenia Research 86, 15–22.CrossRefGoogle ScholarPubMed
Nomesco (2010). NOMESCO Report on Mortality Statistics for the Nordic/Baltic Countries. Nomesco: Copenhagen.Google Scholar
Osmond, C, Kajantie, E, Forsén, TJ, Eriksson, JG, Barker, DJ (2007). Infant growth and stroke in adult life: the Helsinki birth cohort study. Stroke 38, 264–270.CrossRefGoogle ScholarPubMed
Pajunen, P, Koukkunen, H, Ketonen, M, Jerkkola, T, Immonen-Räihä, P, Kärjä-Koskenkari, P, Mähönen, M, Niemelä, M, Kuulasmaa, K, Palomäki, P, Mustonen, J, Lehtonen, A, Arstila, M, Vuorenmaa, T, Lehto, S, Miettinen, H, Torppa, J, Tuomilehto, J, Kesäniemi, YA, Pyörälä, K, Salomaa, V (2005). The validity of the Finnish Hospital Discharge Register and Causes of Death Register data on coronary heart disease. European Journal of Cardiovascular Prevention and Rehabilitation 12, 132–137.Google ScholarPubMed
Perälä, J, Suvisaari, J, Saarni, SI, Kuoppasalmi, K, Isometsä, E, Pirkola, S, Partonen, T, Tuulio-Henriksson, A, Hintikka, J, Kieseppä, T, Härkänen, T, Koskinen, S, Lönnqvist, J (2007). Lifetime prevalence of psychotic and bipolar I disorders in a general population. Archives of General Psychiatry 64, 19–28.CrossRefGoogle ScholarPubMed
Piette, JD, Heisler, M, Ganoczy, D, McCarthy, JF, Valenstein, M (2007). Differential medication adherence among patients with schizophrenia and comorbid diabetes and hypertension. Psychiatric Services 58, 207–212.CrossRefGoogle ScholarPubMed
Pihlajamaa, J, Suvisaari, J, Henriksson, M, Heilä, H, Karjalainen, E, Koskela, J, Cannon, M, Lönnqvist, J (2008). The validity of schizophrenia diagnosis in the Finnish Hospital Discharge Register: findings from a 10-year birth cohort sample. Nordic Journal of Psychiatry 62, 198–203.CrossRefGoogle ScholarPubMed
Plomondon, ME, Ho, PM, Wang, L, Greiner, GT, Shore, JH, Sakai, JT, Fihn, SD, Rumsfeld, JS (2007). Severe mental illness and mortality of hospitalised ACS patients in the VHA. BMC Health Services Research 7, 146.CrossRefGoogle ScholarPubMed
Ray, KK, Seshasai, SRK, Erqou, S, Sever, P, Jukema, JW, Ford, I, Sattar, N (2010). Statins and all-cause mortality in high-risk primary prevention. Archives of Internal Medicine 170, 1024–1031.CrossRefGoogle ScholarPubMed
Tiihonen, J, Haukka, J, Taylor, M, Haddad, PM, Patel, MX, Korhonen, P (2011). A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. American Journal of Psychiatry 168, 603–609.CrossRefGoogle ScholarPubMed
Tiihonen, J, Lönnqvist, J, Wahlbeck, K, Klaukka, T, Niskanen, L, Tanskanen, A, Haukka, J (2009). 11-Year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 374, 620–627.CrossRefGoogle ScholarPubMed
Tolonen, H, Salomaa, V, Torppa, J, Sivenius, J, Immonen-Räihä, P, Lehtonen, A; for the FINSTROKE register (2007). The validation of the Finnish Hospital Discharge Register and Causes of Death Register data on stroke diagnoses. European Journal of Cardiovascular Prevention and Rehabilitation 14, 380–385.CrossRefGoogle ScholarPubMed
Vrecer, M, Turk, S, Drinovec, J, Mrhar, A (2003). Use of statins in primary and secondary prevention of coronary heart disease and ischemic stroke. Meta-analysis of randomized trials. International Journal of Clinical Pharmacology and Therapeutics 41, 567–577.Google ScholarPubMed
Wildgust, HJ, Beary, M (2010). Are there modifiable risk factors which will reduce the excess mortality in schizophrenia? Journal of Psychopharmacology 24,37–50.CrossRefGoogle ScholarPubMed
WHO (2009). Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. WHO Press: Geneva.Google Scholar