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Cardiovascular Disease, Mortality Higher With Serious Mental Illness

Association stronger in most recent decades and among those with schizophrenia

WEDNESDAY, April 20, 2022 (HealthDay News) — People with serious mental illness (SMI), particularly schizophrenia, have higher levels of cardiovascular disease (CVD)-related mortality and a higher incidence of CVD than the general population, according to a systematic review and meta-analysis published online April 19 in PLOS Medicine.

Amanda M. Lambert, from the University of Birmingham in the United Kingdom, and colleagues conducted a systematic literature review to identify studies evaluating associations between SMI and CVD. Temporal changes in the association were investigated.

The researchers identified 108 studies for inclusion in the narrative synthesis, while the quantitative synthesis included 59 mortality studies (with ≥1,841,356 cases and 29,321,409 controls) and 28 incidence studies (≥401,909 cases and 14,372,146 controls). Compared with controls, the risk for CVD-related mortality for people with SMI was higher across most comparisons. Estimated risks were greater for schizophrenia than bipolar disease. Pooled results ranged from a standardized mortality ratio of 1.55 for cerebrovascular accident (CVA) in people with bipolar disease to a hazard ratio/rate ratio of 2.40 for CVA in schizophrenia. Risks for coronary heart disease and CVD mortality were larger for schizophrenia and bipolar disease in studies with outcomes occurring during the 1990s and 2000s versus earlier decades and in studies including people with younger age. With serious mental illness, the incidence of CVA, CVD events, and heart failure in SMI was higher compared with controls.

“The increased relative risk of CVD diagnosis in more recent decades may be a result of disparity in smoking prevalence between people with SMI and the general population or increased use of antipsychotics,” the authors write.

Two authors disclosed financial ties to the pharmaceutical and biopharmaceutical industries.

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