Characterizing Coronary Heart Disease Risk in Chronic Schizophrenia: High Prevalence of the Metabolic Syndrome

By Cohn, Tony; Prud'homme, Denis et al. | Canadian Journal of Psychiatry, November 2004 | Go to article overview

Characterizing Coronary Heart Disease Risk in Chronic Schizophrenia: High Prevalence of the Metabolic Syndrome


Cohn, Tony, Prud'homme, Denis, Streiner, David, Kameh, Homa, Remington, Gary, Canadian Journal of Psychiatry


Objective: To determine the prevalence and characteristics of coronary heart disease (CHD) risk factors in patients with chronic schizophrenia or schizoaffective disorder.

Method: We compared individual CHD risk factors and Framingham risk predictions in a group of 240 patients with a large national sample (Canadian Heart Health Survey) matched for age and sex. In addition, we compared rates of the metabolic syndrome (syndrome X) with recently published rates in the US adult population.

Results: Compared with the reference population, Framingham 10-year risk of myocardial infarction was greater in the male patients (£3091 = 4.35, P < 0.001) but not in the female patients. Prevalence rates of the metabolic syndrome in the patients (42.6% of men and 48.5% of women) were approximately 2 times published rates in the US adult population. Further, the syndrome appears to occur at a younger age than in the general population.

Conclusions: These long-term patients have increased CHD risks best captured by the metabolic syndrome conceptualization coupled with a high rate of cigarette smoking. This characterization is consistent with increased cardiovascular morbidity and decreased life expectancy in both men and women. We underscore the importance of both screening for and treating potentially reversible CHD risk factors in schizophrenia patients.

(Can J Psychiatry 2004;49:753-760)

Clinical Implications

* Patients with chronic schizophrenia and schizoaffective disorder have a characteristic profile of easily measured and potentially reversible cardiovascular risks compatible with reduced life expectancy and increased cardiovascular mortality.

* As part of routine clinical care, body weight, waist circumference, fasting lipids, glucose, and cigarette smoking should be monitored in patients with chronic psychosis. Innovative screening, management, and preventative strategies, including shared care models, should be developed to address these health concerns.

* Prospective and first-episode studies are needed to identify the relative contribution of illness-specific, lifestyle, and psychotropic medication factors in the development of these risks.

Limitations

* The study was confined to hospital-based inpatients and outpatients with chronic schizophrenia or schizoaffective disorder and may not be generalizable to community samples with more recent illness onset or with less severe illness.

* The cross-sectional design and lack of control over previous and concomitant psychotropic medication limits evaluation of the contribution of medication-specific risks.

* Because fasting glucose was not measured as part of the Heart Health Survey, the reference population could not be compared with the study population with respect to rates of the metabolic syndrome, and diabetes could not be factored into the Framingham risk assessment.

Key Words: coronary heart disease, risk factor, schizophrenia, schizoaffective disorder, medical cotnorbidity, metabolic syndrome, syndrome X, Framingham

Schizophrenia has been described as a "life-shortening illness" ( 1 ) that reduces life expectancy by 10 or 15 years (2). This excess mortality cannot be explained by suicide and accidental deaths alone. In a metaanalysis, Brown and others found that physical conditions account for 60% of the excess mortality (3). Further, several studies have established a twofold increase in the standardized mortality ratio for cardiovascular disorders (4-7). For example, Osby and others report a cardiovascular standardized mortality ratio of 2.3 (95%CI, 1.6 to 4.2) for men and 2.1 (95%CI, 1.9 to 2.4) for women who received a first hospital diagnosis of schizophrenia from 1973 to 1995 in Stockholm County, Sweden (8).

Coronary heart disease (CHD) is the leading cause of death for both men and women in developed countries. Patients with schizophrenia are known to have high prevalence rates of cigarette smoking (9), diabetes (10,11), and less healthy lifestyles (12), which raises concerns about cardiovascular health. …

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