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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: [email protected])
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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

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