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Published on: November 19, 2020
Schizophrenia and increased risks of cardiovascular disease
Charles H Hennekens1, Alissa R Hennekens, Danielle Hollar
1Department of Biomedical Science, Center of Excellence in Biomedical and Marine Biotechnology, Florida Atlantic University, FL, USA. profchhmd@prodigy.net
Insights
Patients with schizophrenia have a 20% shorter life expectancy, with coronary heart disease (CHD) being the primary cause of premature death due to adverse risk factors. Addressing these factors is crucial for improving outcomes.
Area of Science:
- Psychiatry and Public Health
- Cardiovascular Medicine
- Epidemiology
Background:
- Schizophrenia is associated with significantly reduced life expectancy compared to the general population.
- Premature mortality in schizophrenia is a critical public health concern.
- Understanding the leading causes of death is essential for targeted interventions.
Purpose of the Study:
- To review the absolute and relative impacts of major causes of premature mortality in schizophrenia patients.
- To identify key risk factors contributing to excess mortality.
Main Methods:
- Systematic review of published articles on mortality in the general population and schizophrenia patients.
- Selection of studies reporting total and cause-specific mortality rates.
- Analysis of mortality causes and associated risk factors.
Main Results:
- Schizophrenia patients have an average life expectancy 15 years shorter than the general population (61 vs. 76 years).
- Coronary heart disease (CHD) is the leading cause of death, accounting for over two-thirds of deaths in schizophrenia patients.
- Key risk factors for excess mortality include smoking, obesity, dyslipidemia, insulin resistance, diabetes, and hypertension.
Conclusions:
- Coronary heart disease (CHD) is the primary driver of premature mortality in schizophrenia, largely due to an adverse risk factor profile.
- Challenges in healthcare access, utilization, and adherence exacerbate mortality risks.
- Developing antipsychotic regimens that do not worsen CHD risk factors is a significant clinical and public health challenge.
Objective:
The aim of the study is to review the absolute and relative impacts of the major causes for premature mortality among patients with schizophrenia.
Data Sources:
We reviewed published articles on causes of mortality in the general population as well as among patients with schizophrenia.
Study Selection:
We selected articles which published total and cause-specific mortality rates.
Data Extraction:
We reviewed the causes of mortality and their risk factors.
Data Synthesis:
The average life expectancy of the general population is 76 years (72 years in men, 80 years in women), whereas the corresponding figure is 61 years (57 years in men, 65 years in women) among patients with schizophrenia. Thus, patients with schizophrenia have approximately a 20% reduced life expectancy compared with the general population. Although patients with schizophrenia are 10 to 20 times more likely than the general population to commit suicide, more than two thirds of patients with schizophrenia, compared with approximately one-half in the general population, die of coronary heart disease (CHD). The chief risk factors for this excess risk of death are cigarette smoking, obesity leading to dyslipidemia, insulin resistance and diabetes, and hypertension.
Conclusions:
The chief cause of excess premature mortality among patients with schizophrenia is CHD, caused mainly by their adverse risk factor profile. Because patients with schizophrenia have less access to medical care, consume less medical care, and are less compliant with their regimens, the choice of antipsychotic drug regimens that do not further adversely affect their risk factor for CHD is a major clinical and public health challenge among patients with schizophrenia.
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