Cardiometabolic Biomarkers at Age 44-45 in the Psychosis Spectrum: The British National Child Development Study

Excess mortality in psychotic disorders is largely due to preventable cardiometabolic morbidity. Efforts to evaluate the link between the psychosis spectrum and cardiometabolic health have been confounded by early-life adversity (ELA) and biased sampling. This population-based study examined prospective associations between psychosis-spectrum status and cardiometabolic biomarkers at age 44-45, adjusting for ELA.

We analyzed data from the 2002/03 biomedical sweep of the British National Child Development Study (n = 9377; age 44-45). Psychosis-spectrum status (exposure; n = 171) was defined using repeated screening across adulthood (ages 23 to 44-45), including self-reported diagnoses, antipsychotic medication use, or professional help-seeking for hallucinations. Cardiometabolic biomarkers at age 44-45 (outcomes) were compared between individuals on the psychosis spectrum and psychosis-free controls (comparator; n = 2448). Analyses were conducted using unimputed and multiply imputed datasets (n = 7391-9298), adjusting for 24 indicators of ELA.

In both unimputed/imputed analyses, individuals on the psychosis spectrum had significantly worse cardiometabolic profiles. Adjusted results showed elevated abdominal obesity (exp(b), 1.404; 95% CI, 1.177-1.676; P < .001), higher glycated hemoglobin (B = 0.321; 95% CI, 0.089-0.553; P = .008), lower high-density lipoprotein cholesterol (B = -4.472; 95% CI, -7.782 to -1.162; P = .009), and increased fibrinogen (B = 4.542; 95% CI, 0.939-8.144; P = .015) compared to controls.

Overcoming early-life confounders and biases that limited prior research, our study demonstrates a robust, independent association between psychosis-spectrum status and cardiometabolic dysfunction at age 44-45. These findings underscore the urgent need for comprehensive screening, treatment, and monitoring of cardiometabolic morbidity in psychosis, guided by a life-course perspective.