+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

A case-control study of cardiovascular risk factors and cardiovascular risk among patients with schizophrenia in a country in the low cardiovascular risk region of Europe

A case-control study of cardiovascular risk factors and cardiovascular risk among patients with schizophrenia in a country in the low cardiovascular risk region of Europe

Revista Portuguesa de Cardiologia 29(10): 1481-1493

Patients with serious mental illness have increased cardiovascular risk factors and excess mortality from cardiovascular disease that are in part favored by adverse effects of treatment. Given the wide geographical variation of vascular atherosclerotic disease there is a recognized need for national studies. The prevalence of risk factors and estimated absolute and relative cardiovascular risk by means of SCORE risk charts were ascertained in 125 schizophrenia outpatients and 1721 age- and gender-matched primary care center users. Patients with schizophrenia have a very high prevalence of cardiovascular risk factors. Higher values were observed for smoking (65.0%), clinical or laboratory dyslipidemia (59.1% and 52.0%), careless diet (78.4%), sedentary lifestyle (64.2%), overweight or obesity (64.2%) and abdominal obesity (50.9%). Lower values were observed for hypertension (25.0%), metabolic syndrome (21.9%), diabetes (9.6%) and alcohol abuse (4.0%). An association risk factor exposure and disease was documented (odds ratio, [95% confidence limits]) for smoking (2.47 [1.68-3.64]), laboratory dyslipidemia (1.92 [1.33-2.77]), low HDL-C (2.12 [1.31-3.42]), careless diet (4.46 [2.88-6.90]) and sedentary lifestyle (1.79 [1.22-2.62]). A significant association between antipsychotics that are more likely to induce weight gain and overweight or obesity could not be demonstrated in this study. Hypertension was 46% lower in cases (n = 26/125) than in controls (0.54 [0.34-0.84]). This rather surprising result could be explained by our finding of a negative association (p = 0.01) between blood pressure levels and rate of benzodiazepine prescription among schizophrenia patients. The negative association documented in these patients by multivariate regression analysis (p = 0.005) between hypertension and benzodiazepine prescription reinforces this explanation. Untreated hypertension, untreated dyslipidemia and untreated diabetes are strongly associated with schizophrenia (3.79 [1.63-8.81]), (3.79 [2.06-7.35]), (6.38 [1.725-23.59]), respectively. A significant difference in 10-year absolute risk of fatal cardiovascular disease between cases and controls aged 40 years or more could not be demonstrated in our study (p = 0.054). Nonetheless, in younger individuals, higher levels of relative risk multiples in the 2-12 range were found in schizophrenia patients compared to controls (p < 0.050). In schizophrenia patients, a high prevalence of cardiovascular risk factors and of neglected treatment was found. The great majority of cases and controls aged 40 years or more have low and comparable levels of absolute cardiovascular risk mortality. For those aged under 40 years, schizophrenia patients show higher relative cardiovascular risk than controls. These findings call for closer collaboration between psychiatrists and primary care providers. The finding of a lower prevalence of hypertension among cases seems to be associated with an apparent protective effect of benzodiazepines, which are frequently prescribed to patients with schizophrenia in Portugal.

(PDF emailed within 1 workday: $29.90)

Accession: 051097695

Download citation: RISBibTeXText

PMID: 21265491

Related references

Renal function and attributable risk of death and cardiovascular hospitalization in patients with cardiovascular risk factors from a registry-based cohort: the Estudio Cardiovascular Valencia-risk study. Journal of Hypertension 34(11): 2266-2273, 2017

Prevalence and awareness of cardiovascular risk factors in patients with schizophrenia: a cross-sectional study in a low cardiovascular disease risk geographical area. European Psychiatry 24(7): 431-441, 2009

Survey of cardiovascular risk factors in overweight and obese patients (SCOOP study) six-month changes in risk factor levels and cardiovascular risk. European Journal of Internal Medicine 20(3): 280-288, 2009

Framingham Risk Score underestimates cardiovascular disease risk in severe psoriatic patients: implications in cardiovascular risk factors management and primary prevention of cardiovascular disease. Journal of Dermatology 40(11): 923-926, 2015

Smoking cessation and the risk of cardiovascular disease outcomes predicted from established risk scores: results of the Cardiovascular Risk Assessment among Smokers in Primary Care in Europe (CV-ASPIRE) study. Bmc Public Health 13: 362, 2013

Does the Theory of Relativity Apply to Cardiovascular Risk? Changes in the Spectrum of Cardiovascular Risk Factors in Elderly Patients - Case Report. Revista Medico-Chirurgicala a Societatii de Medici Si Naturalisti Din Iasi 120(3): 558-562, 2018

Cardiovascular risk factors and cardiovascular diseases in patients with moderate to severe psoriasis under systemic treatment. PSO-RISK, descriptive study. European Journal of Dermatology 24(6): 662-669, 2015

Cardiovascular risk assessment according to a national calibrated score risk index in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. Joint, Bone, Spine 81(2): 164-168, 2014

Impact of hypertension on mortality and cardiovascular disease burden in patients with cardiovascular risk factors from a general practice setting: the ESCARVAL-risk study. Journal of Hypertension 34(6): 1075-1083, 2016

Impact of dyslipidemia on cardiovascular risk stratification of hypertensive patients and association of lipid profile with other cardiovascular risk factors: results from the ICEBERG study. Integrated Blood Pressure Control 1: 5-13, 2008

Familial predisposition to cardiovascular risk and disease contributes to cardiovascular risk and disease interacting with other cardiovascular risk factors in diabetes: implication for common soil (JDDM 14). Atherosclerosis 201(2): 332-338, 2008

Chromium Exposure and Risk of Cardiovascular Disease in High Cardiovascular Risk Subjects - Nested Case-Control Study in the Prevention With Mediterranean Diet (PREDIMED) Study. Circulation Journal 81(8): 1183-1190, 2017

Cardiovascular secondary prevention: patients' knowledge of cardiovascular risk factors and their attitude to reduce the risk burden, and the practice of family doctors. The "Help Your Heart Stay Young" study. Italian Heart Journal 5(10): 767-773, 2005

Cardiovascular risk estimated after 13 years of follow-up in a low-incidence Mediterranean region with high-prevalence of cardiovascular risk factors. Bmc Public Health 10(): 640-640, 2011

Cardiovascular disease, cardiovascular risk factors and albuminuria in insulin-dependent diabetic patients in Europe. Diabetologia 36(SUPPL 1): A205, 1993