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RESEARCH PRODUCT

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

Francesco MonacoDavide GallicchioStella RossonChristoph U. CorrellBrendon StubbsPaolo SantonastasoFiona GaughranMichele FornaroCristiano A. KöhlerMarco SolmiBeatrice BortolatoNita Thapa-chhetriAndré F. CarvalhoAngela FavaroGiorgio PigatoDavy VancampfortNicola VeronesePhilip B. WardEnrico Collantoni

subject

medicine.medical_specialtyCardiovascular disease; bipolar disorder; cerebrovascular disease; congestive heart failure; coronary heart disease; major depression; premature mortality; schizophrenia; severe mental illness03 medical and health sciences0302 clinical medicinesevere mental illnessMedicineCardiovascular disease severe mental illness schizophrenia bipolar disorder major depression coronary heart disease cerebrovascular disease congestive heart failure premature mortalitycoronary heart diseasePsychiatrybipolar disorderFramingham Risk Scorebusiness.industryVascular diseaseIncidence (epidemiology)Hazard ratioCorrectionOdds ratiomedicine.diseaseCardiovascular disease030227 psychiatrycerebrovascular diseaseschizophreniaPsychiatry and Mental healthcongestive heart failurepremature mortalityHeart failureMajor depressive disorderPshychiatric Mental Healthbusinessmajor depressionBody mass index030217 neurology & neurosurgery

description

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. controls. Moreover, CVD prevalence (p=0.007), but not CVD incidence (p=0.21), increased in more recently conducted studies. This large-scale meta-analysis confirms that SMI patients have significantly increased risk of CVD and CVD-related mortality, and that elevated body mass index, antipsychotic use, and CVD screening and management require urgent clinical attention. © 2017 World Psychiatric Association

yearjournalcountryeditionlanguage
2017-05-12
10.1002/wps.20420http://hdl.handle.net/11588/709307