Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls.

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

People with severe mental illness (SMI) - schizophrenia, bipolar disorder and major depressive disorder - appear at risk for cardiovascular disease (CVD), but a comprehensive meta-analysis is lacking. We conducted a large-scale meta-analysis assessing the prevalence and incidence of CVD; coronary heart disease; stroke, transient ischemic attack or cerebrovascular disease; congestive heart failure; peripheral vascular disease; and CVD-related death in SMI patients (N=3,211,768) versus controls (N=113,383,368) (92 studies). The pooled CVD prevalence in SMI patients (mean age 50 years) was 9.9% (95% CI: 7.4-13.3). Adjusting for a median of seven confounders, patients had significantly higher odds of CVD versus controls in cross-sectional studies (odds ratio, OR=1.53, 95% CI: 1.27-1.83; 11 studies), and higher odds of coronary heart disease (OR=1.51, 95% CI: 1.47-1.55) and cerebrovascular disease (OR=1.42, 95% CI: 1.21-1.66). People with major depressive disorder were at increased risk for coronary heart disease, while those with schizophrenia were at increased risk for coronary heart disease, cerebrovascular disease and congestive heart failure. Cumulative CVD incidence in SMI patients was 3.6% (95% CI: 2.7-5.3) during a median follow-up of 8.4 years (range 1.8-30.0). Adjusting for a median of six confounders, SMI patients had significantly higher CVD incidence than controls in longitudinal studies (hazard ratio, HR=1.78, 95% CI: 1.60-1.98; 31 studies). The incidence was also higher for coronary heart disease (HR=1.54, 95% CI: 1.30-1.82), cerebrovascular disease (HR=1.64, 95% CI: 1.26-2.14), congestive heart failure (HR=2.10, 95% CI: 1.64-2.70), and CVD-related death (HR=1.85, 95% CI: 1.53-2.24). People with major depressive disorder, bipolar disorder and schizophrenia were all at increased risk of CVD-related death versus controls. CVD incidence increased with antipsychotic use (p=0.008), higher body mass index (p=0.008) and higher baseline CVD prevalence (p=0.03) in patients vs.

Related collections

Most cited references 89

Record: found
Abstract: found
Article: not found

Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder.

Christoph U. Correll, Johan Detraux, Jan De Lepeleire … (2015)

People with severe mental illness have a considerably shorter lifespan than the general population. This excess mortality is mainly due to physical illness. Next to mental illness-related factors, unhealthy lifestyle, and disparities in health care access and utilization, psychotropic medications can contribute to the risk of physical morbidity and mortality. We systematically reviewed the effects of antipsychotics, antidepressants and mood stabilizers on physical health outcomes in people with schizophrenia, depression and bipolar disorder. Updating and expanding our prior systematic review published in this journal, we searched MEDLINE (November 2009 - November 2014), combining the MeSH terms of major physical disease categories (and/or relevant diseases within these categories) with schizophrenia, major depressive disorder and bipolar disorder, and the three major psychotropic classes which received regulatory approval for these disorders, i.e., antipsychotics, antidepressants and mood stabilizers. We gave precedence to results from (systematic) reviews and meta-analyses wherever possible. Antipsychotics, and to a more restricted degree antidepressants and mood stabilizers, are associated with an increased risk for several physical diseases, including obesity, dyslipidemia, diabetes mellitus, thyroid disorders, hyponatremia; cardiovascular, respiratory tract, gastrointestinal, haematological, musculoskeletal and renal diseases, as well as movement and seizure disorders. Higher dosages, polypharmacy, and treatment of vulnerable (e.g., old or young) individuals are associated with greater absolute (elderly) and relative (youth) risk for most of these physical diseases. To what degree medication-specific and patient-specific risk factors interact, and how adverse outcomes can be minimized, allowing patients to derive maximum benefits from these medications, requires adequate clinical attention and further research.

0 comments Cited 258 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Excess early mortality in schizophrenia.

Thomas Laursen, Merete Nordentoft, Preben Mortensen (2014)

Schizophrenia is often referred to as one of the most severe mental disorders, primarily because of the very high mortality rates of those with the disorder. This article reviews the literature on excess early mortality in persons with schizophrenia and suggests reasons for the high mortality as well as possible ways to reduce it. Persons with schizophrenia have an exceptionally short life expectancy. High mortality is found in all age groups, resulting in a life expectancy of approximately 20 years below that of the general population. Evidence suggests that persons with schizophrenia may not have seen the same improvement in life expectancy as the general population during the past decades. Thus, the mortality gap not only persists but may actually have increased. The most urgent research agenda concerns primary candidates for modifiable risk factors contributing to this excess mortality, i.e., side effects of treatment and lifestyle factors, as well as sufficient prevention and treatment of physical comorbidity.

0 comments Cited 248 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Depression and the risk of coronary heart disease: a meta-analysis of prospective cohort studies

Yong Gan, Yanhong Gong, Xinyue Tong … (2014)

Background Several systematic reviews and meta-analyses demonstrated the association between depression and the risk of coronary heart disease (CHD), but the previous reviews had some limitations. Moreover, a number of additional studies have been published since the publication of these reviews. We conducted an updated meta-analysis of prospective studies to assess the association between depression and the risk of CHD. Methods Relevant prospective studies investigating the association between depression and CHD were retrieved from the PubMed, Embase, Web of Science search (up to April 2014) and from reviewing reference lists of obtained articles. Either a random-effects model or fixed-effects model was used to compute the pooled risk estimates when appropriate. Results Thirty prospective cohort studies with 40 independent reports met the inclusion criteria. These groups included 893,850 participants (59,062 CHD cases) during a follow-up duration ranging from 2 to 37 years. The pooled relative risks (RRs) were 1.30 (95% CI, 1.22-1.40) for CHD and 1.30 (95% CI, 1.18-1.44) for myocardial infarction (MI). In the subgroup analysis by follow-up duration, the RR of CHD was 1.36 (95% CI, 1.24-1.49) for less than 15 years follow-up, and 1.09 (95% CI, 0.96-1.23) for equal to or more than 15 years follow-up. Potential publication bias may exist, but correction for this bias using trim-and-fill method did not alter the combined risk estimate substantially. Conclusions The results of our meta-analysis suggest that depression is independently associated with a significantly increased risk of CHD and MI, which may have implications for CHD etiological research and psychological medicine. Electronic supplementary material The online version of this article (doi:10.1186/s12888-014-0371-z) contains supplementary material, which is available to authorized users.

0 comments Cited 145 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (iso-abbrev): World Psychiatry

Title: World psychiatry : official journal of the World Psychiatric Association (WPA)

Publisher: Wiley-Blackwell

ISSN: 1723-8617

ISSN (Print): 1723-8617

Publication date (Electronic): Jun 2017

Volume: 16

Issue: 2

Affiliations

[1 ] Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.

[2 ] Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA.

[3 ] Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA.

[4 ] Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.

[5 ] Institute for Clinical Research and Education in Medicine, Padua, Italy.

[6 ] Department of Neurosciences, University of Padua, Padua, Italy.

[7 ] Mental Health Department, Local Health Unit 17, Padua, Italy.

[8 ] Mental Health Department, Local Health Unit 10, Portogruaro, Italy.

[9 ] University of Connecticut Health Center, Farmington, CT, USA.

[10 ] New York Psychiatric Institute, Columbia University, New York, NY, USA.

[11 ] Department of Clinical Medicine and Translational Psychiatry Research Group, Federal University of Ceará, Fortaleza, Brazil.

[12 ] KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.

[13 ] KU Leuven University Psychiatric Center, Leuven-Kortenberg, Belgium.

[14 ] School of Psychiatry, University of New South Wales, Sydney, Australia.

[15 ] South London and Maudsley, NHS Foundation Trust, London, UK.

[16 ] Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

[17 ] Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

Article

DOI: 10.1002/wps.20420

PMC ID: 5428179

PubMed ID: 28498599

SO-VID: 7e29848c-ea5c-45d2-9a1e-32a2e37041ce

History

Keywords: Cardiovascular disease,bipolar disorder,cerebrovascular disease,congestive heart failure,coronary heart disease,major depression,premature mortality,schizophrenia,severe mental illness

Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls.

Read this article at

Abstract

Related collections

Measurement of Glucocorticoid Receptor Signaling in Major Depression

Most cited references 89

Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder.

Excess early mortality in schizophrenia.

Depression and the risk of coronary heart disease: a meta-analysis of prospective cohort studies

Author and article information

Journal

Affiliations

Article

History

Comments

Comment on this article

Similar content 184

Cited by 509