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Cardiovascular risk factors among patients with schizophrenia, bipolar, depressive, anxiety, and personality disorders

Published online by Cambridge University Press:  23 March 2020

M. Pérez-Piñar ,
R. Mathur ,
Q. Foguet ,
S. Ayis ,
J. Robson  and
L. Ayerbe
M. Pérez-Piñar
Affiliation:
The Westborough Road Health Centre, Westcliff-on-Sea, United Kingdom
R. Mathur
Affiliation:
Centre for Primary Care and Public Health, Queen Mary university of London, London, United Kingdom
Q. Foguet
Affiliation:
Institut Universitari d’Investigació en Atenció Primària Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain
S. Ayis
Affiliation:
Division of Health and Social Care Research, King’s College London, London, United Kingdom
J. Robson
Affiliation:
Centre for Primary Care and Public Health, Queen Mary university of London, London, United Kingdom
L. Ayerbe*
Affiliation:
The Westborough Road Health Centre, Westcliff-on-Sea, United Kingdom Centre for Primary Care and Public Health, Queen Mary university of London, London, United Kingdom
*
* Corresponding author. at: Centre for Primary Care and Public Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London E1 2AB, United Kingdom. E-mail address:[email protected] (L. Ayerbe).
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Abstract

Background

The evidence informing the management of cardiovascular risk in patients with psychiatric disorders is weak.

Methods

This cohort study used data from all patients, aged ≥ 30, registered in 140 primary care practices (n = 524,952) in London to estimate the risk of developing diabetes, hypertension, hyperlipidemia, tobacco consumption, obesity, and physical inactivity, between 2005 and 2015, for patients with a previous diagnosis of schizophrenia, depression, anxiety, bipolar or personality disorder. The role of antidepressants, antipsychotics and social deprivation in these associations was also investigated. The age at detection of cardiovascular risk factor was compared between patients with and without psychiatric disorders. Variables, for exposures and outcomes, defined from general practitioners records, were analysed using multivariate regression.

Results

Patients with psychiatric disorders had an increased risk for cardiovascular risk factors, especially diabetes, with hazard ratios: 2.42 (2.20–2.67) to 1.31 (1.25–1.37), hyperlipidemia, with hazard ratios: 1.78 (1.60–1.97) to 1.25 (1.23–1.28), and obesity. Antidepressants, antipsychotics and social deprivation did not change these associations, except for smoking and physical inactivity. Antidepressants were associated with higher risk of diabetes, hypertension and hyperlipidemia. Antipsychotics were associated with a higher risk of diabetes. Antidepressants and antipsychotics were associated with lower risk of other risk factors. Patients with psychiatric conditions have later detection of cardiovascular risk factors. The interpretation of these results should acknowledge the lower rates of detection of risk factors in mentally ill patients.

Conclusions

Cardiovascular risk factors require special clinical attention among patients with psychiatric disorders. Further research could study the effect of antidepressants and antipsychotics on cardiovascular risk factors.

Keywords

Cardiovascular diseasesSchizophreniaAntipsychotic agentsAntidepressive agentsSocioeconomic factorsCohort studies
Type
Original article
Information
European Psychiatry , Volume 35 , May 2016 , pp. 8 - 15
Copyright
Copyright © European Psychiatry 2016

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References

Colton, CWManderscheid, RWCongruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis 2006; 3(2):A42Google ScholarPubMed
Viron, MJStern, TAThe impact of serious mental illness on health and healthcare. Psychosomatics 2010; 51(6): 458–465CrossRefGoogle ScholarPubMed
Osborn, DPWright, CALevy, GKing, MBDeo, RNazareth, IRelative risk of diabetes, dyslipidaemia, hypertension and the metabolic syndrome in people with severe mental illnesses: systematic review and metaanalysis. BMC Psychiatry 8 2008 84CrossRefGoogle ScholarPubMed
Stubbs, BWilliams, JGaughran, FCraig, THow sedentary are people with psychosis? A systematic review and meta-analysis. Schizophr Res 2016; 171(1–3.):CrossRefGoogle ScholarPubMed
De Leon, JDiaz, FJA meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophr Res 2005; 76(2–3):135–157CrossRefGoogle ScholarPubMed
Meng, LChen, DYang, YZheng, YHui, RDepression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies. J Hypertens 2012; 30(5): 842–851CrossRefGoogle ScholarPubMed
Vancampfort, DStubbs, BMitchell, AJDe Hert, MWampers, MWard, PBet al.Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis World Psychiatry 2015; 14(3): 339–347CrossRefGoogle ScholarPubMed
Vancampfort, DMitchell, AJDe Hert, MSienaert, PProbst, MBuys, Ret al.Type 2 Diabetes in patients with major depressive disorder: a meta-analysis of prevalence estimates and predictors Depress Anxiety 2015; 32(10): 763–773CrossRefGoogle ScholarPubMed
Stubbs, BVancampfort, DDe Hert, MMitchell, AJThe prevalence and predictors of type two diabetes mellitus in people with schizophrenia: a systematic review and comparative meta-analysis. Acta Psychiatr Scand 2015; 132(2): 144–157CrossRefGoogle ScholarPubMed
Vancampfort, DMitchell, AJDe Hert, MSienaert, PProbst, MBuys, Ret al.Prevalence and predictors of type 2 diabetes mellitus in people with bipolar disorder: a systematic review and meta-analysis J Clin Psychiatry 2015; 76(11): 1490–1499CrossRefGoogle ScholarPubMed
Correll, CUDetraux, JDe Lepeleire, JDe Hert, MEffects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry 2015; 14(2): 119–136CrossRefGoogle ScholarPubMed
Andersohn, FSchade, RSuissa, SGarbe, ELong-term use of antidepressants for depressive disorders and the risk of diabetes mellitus. Am J Psychiatry 2009; 166(5): 591–598CrossRefGoogle ScholarPubMed
Grossman, EMesserli, FHDrug-induced hypertension: an unappreciated cause of secondary hypertension. Am J Med 2012; 125(1): 14–22CrossRefGoogle ScholarPubMed
Galling, BRoldán, ANielsen, RENielsen, JGerhard, TCarbon, Met al.Type 2 diabetes mellitus in youth exposed to antipsychotics: a systematic review and meta-analysis JAMA Psychiatry 2016; 73(3): 247–259CrossRefGoogle ScholarPubMed
Addo, JAyerbe, LMohan, KMCrichton, SSheldenkar, AChen, Ret al.Socioeconomic status and stroke: an updated review Stroke 2012; 43(4): 1186–1191CrossRefGoogle Scholar
Rao, SVKaul, PNewby, LKLincoff, AMHochman, JHarrington, RAet al.Poverty, process of care, and outcome in acute coronary syndromes J Am Coll Cardiol 2003; 41(11): 1948–1954CrossRefGoogle ScholarPubMed
Patel, VLund, CHatherill, SPlagerson, SCorrigall, JFunk, Met al.Blas, E.Kurup, A.S.Equity, social determinants and public health programmes World Health Organization Geneva 2010 115–134Google Scholar
Gallo, VEgger, MMcCormack, VFarmer, PBIoannidis, JPKirsch-Volders, Met al.Strengthening the reporting of observational studies in epidemiology–molecular epidemiology (STROBE-ME): an extension of the STROBE Statement. PLoS Med 8 2011 e1001117CrossRefGoogle ScholarPubMed
Perk, JDe Backer, GGohlke, HGraham, IReiner, ZVerschuren, Met al.European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) Eur Heart J 2012; 33(13): 1635–1701Google Scholar
NICE Pathways. Cardiovascular disease prevention 2016 [Available from: http://www.pathways.nice.org.uk/pathways/cardiovascular-disease-prevention; accessed February 2016]Google Scholar
Jarman, BTownsend, PCarstairs, VDeprivation indices. BMJ 1991; 303(6801): 523CrossRefGoogle ScholarPubMed
British National Formulary 2015 [Available from: http://www.medicinescomplete.com/mc/bnf/current/; accessed December 2015]Google Scholar
Eckel, RHJakicic, JMArd, JDde Jesus, JMHouston Miller, NHubbard, VSet al.AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63(25 Pt B): 2960–2984CrossRefGoogle Scholar
Mitchell, AJVaze, ARao, SClinical diagnosis of depression in primary care: a meta-analysis. Lancet 2009; 22(374): 609–619CrossRefGoogle Scholar
Osborn, DPBaio, GWalters, KPetersen, ILimburg, HRaine, Ret al.Inequalities in the provision of cardiovascular screening to people with severe mental illnesses in primary care: cohort study in the United Kingdom THIN Primary Care Database 2000–2007. Schizophr Res 2011; 129(2–3):104–110CrossRefGoogle ScholarPubMed
Quality and Outcomes Framework. NHS The Information Centre [Available on: http://www.qof.ic.nhs.uk/; accessed November 2015].Google Scholar
Chaiton, MOCohen, JEO’Loughlin, JRehm, JA systematic review of longitudinal studies on the association between depression and smoking in adolescents. BMC Public Health 2009; 22(9): 356CrossRefGoogle Scholar
Hasan, SSClavarino, AMMamun, AAKairuz, TIncidence and risk of diabetes mellitus associated with depressive symptoms in adults: evidence from longitudinal studies. Diabetes Metab Syndr 2014; 8(2): 82–87CrossRefGoogle ScholarPubMed
Luppino, FSde Wit, LMBouvy, PFStijnen, TCuijpers, PPenninx, BWet al.Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies Arch Gen Psychiatry 2010; 67: 220–229CrossRefGoogle ScholarPubMed
Stahl, SEssential psychopharmacology New York: Cambridge University Press; 2013Google Scholar
Miron, ICBaroană, VCPopescu, FIonică, FPharmacological mechanisms underlying the association of antipsychotics with metabolic disorders. Curr Health Sci J 2014; 40(1): 12–17Google ScholarPubMed
Hughes, JRStead, LFHartmann-Boyce, JCahill, KLancaster, TAntidepressants for smoking cessation. Cochrane Database Syst Rev 1 2014 Cd000031Google Scholar
Chapman, SRagg, MMcGeechan, KCitation bias in reported smoking prevalence in people with schizophrenia. Aust N Z J Psychiatry 2009; 43(3): 277–282CrossRefGoogle ScholarPubMed
Soundy, ARoskell, CStubbs, BVancampfort, DSelection, use and psychometric properties of physical activity measures to assess individuals with severe mental illness: a narrative synthesis. Arch Psychiatr Nurs 2014; 28(2): 135–151CrossRefGoogle ScholarPubMed
Mitchell, AJVancampfort, DDe Hert, MStubbs, BDo people with mental illness receive adequate smoking cessation advice? A systematic review and meta-analysis. Gen Hosp Psychiatry 2015; 37(1): 14–23CrossRefGoogle ScholarPubMed
Foguet i Boreu, QPhysical health and severe mental illness Barcelona: Butlletí de la Medicina de Familia a Catalunya; 2012 [Available from: http://www.pub.bsalut.net/butlleti/vol30/iss2/5; accessed February 2016]Google Scholar
Fernández-San-Martín, MIMartín-López, LMMasa-Font, ROlona-Tabueña, NRoman, YMartin-Royo, Jet al.The effectiveness of lifestyle interventions to reduce cardiovascular risk in patients with severe mental disorders: meta-analysis of intervention studies. Community Ment Health J 2014; 50(1): 81–95CrossRefGoogle ScholarPubMed
Firth, JCotter, JElliott, RFrench, PYung, ARSystematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychol Med 2015; 45(7): 1343–1361CrossRefGoogle ScholarPubMed
Bennett, MEWilson, ALGenderson, MSaperstein, AMSmoking cessation in people with schizophrenia. Curr Drug Abuse Rev 2013; 6(3): 180–190CrossRefGoogle ScholarPubMed
Kennedy, EKumar, ADatta, SSAntipsychotic medication for childhood-onset schizophrenia. Cochrane Database Syst Rev 3 2007 Cd004027Google Scholar
Arroll, BElley, CRFishman, TGoodyear-Smith, FAKenealy, TBlashki, Get al.Antidepressants versus placebo for depression in primary care. Cochrane Database Syst Rev 2009 Cd00795410.1002/14651858Google ScholarPubMed
Kapczinski, Fdos, S.S.J.J.Batista MdCAA, Schmitt, RRAntidepressants for generalised anxiety disorder (GAD). Cochrane Database Syst Rev 2 2003 CD003592Google Scholar
Mottram, PWilson, KStrobl, JAntidepressants for depressed elderly. Cochrane Database Syst Rev 1 2006 Cd003491Google Scholar
Marriott, RGNeil, WWaddingham, SAntipsychotic medication for elderly people with schizophrenia. Cochrane Database Syst Rev 1 2006 Cd005580Google Scholar
Essali, AAli, GAntipsychotic drug treatment for elderly people with late-onset schizophrenia. Cochrane Database Syst Rev 2 2012 Cd004162Google Scholar
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