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Cardiovascular drug use and mortality in patients with schizophrenia or bipolar disorder: a Danish population-based study

Published online by Cambridge University Press:  18 November 2013

T. M. Laursen ,
P. B. Mortensen ,
J. H. MacCabe ,
D. Cohen  and
C. Gasse
T. M. Laursen*
Affiliation:
National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
P. B. Mortensen
Affiliation:
National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
J. H. MacCabe
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, London, UK
D. Cohen
Affiliation:
Department of Severe Mental Illness, Mental Health Organization North-Holland North, The Netherlands
C. Gasse
Affiliation:
National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
*
* Address for correspondence: T. M. Laursen, National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Building K, 8210 Aarhus V, Denmark. (Email: [email protected])
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Abstract

Background

Cardiovascular (CV) co-morbidity is one of the major modifiable risk factors driving the excess mortality in individuals with schizophrenia or bipolar disorder. Population-based studies in this area are sparse.

Method

We used Danish population registers to calculate incidence rate ratios (IRRs) for CV drug use, and mortality rate ratios comparing subjects with schizophrenia or bipolar disorder with subjects with no prior psychiatric hospitalization.

Results

IRRs for CV prescriptions were significantly decreased in patients with schizophrenia or bipolar disorder compared with the general population. Among persons without previous myocardial infarction (MI) or cerebrovascular disease, persons with schizophrenia or bipolar disorder had an up to 6- and 15-fold increased mortality from all causes or unnatural causes, respectively, compared with the general population, being most pronounced among those without CV treatment (16-fold increase). Among those with previous MI or cerebrovascular disease, excess all-cause and unnatural death was lower (up to 3-fold and 7-fold increased, respectively), but was similar in CV-treated and -untreated persons.

Conclusions

The present study shows an apparent under-prescription of most CV drugs among patients with schizophrenia or bipolar disorder compared with the general population in Denmark. The excess of mortality by unnatural deaths in the untreated group suggests that the association between CV treatment and mortality may be confounded by severity of illness. However, our results also suggest that treatment of CV risk factors is neglected in these patients.

Keywords

Bipolar disordercardiovascular drugsmortalityschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 8 , June 2014 , pp. 1625 - 1637
Copyright
Copyright © Cambridge University Press 2013 

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