Academic journal article Indian Journal of Psychiatry

Cardiac Risk Factors and Metabolic Syndrome in Patients with Schizophrenia Admitted to a General Hospital Psychiatric Unit

Academic journal article Indian Journal of Psychiatry

Cardiac Risk Factors and Metabolic Syndrome in Patients with Schizophrenia Admitted to a General Hospital Psychiatric Unit

Article excerpt

Byline: Sandeep. Grover, Naresh. Nebhinani, Subho. Chakrabarti, Ajit. Avasthi, Debasish. Basu, Parmanand. Kulhara, Surendra. Mattoo, Savita. Malhotra

Objective: The study aimed to evaluate the prevalence of cardiovascular risk (CVR) factors and metabolic syndrome (MS) in patients with schizophrenia. Materials and Methods: By consecutive sampling, 143 patients (of age ≥ 20 years), out of total 159 patients with schizophrenia admitted to the inpatient unit were evaluated for the coronary heart disease (CHD) risk as per Framingham (10-year all CHD events) function/risk equation and systematic coronary risk evaluation (SCORE) - 10-year cardiovascular mortality risk (CMR). Prevalence of MS was estimated by using the consensus definition. Results: Fifty-two (36.4%) patients fulfilled the criteria for MS. 10-year CHD risk was 1.65%, and 10-year CMR was 1.39%. Compared to females, males had higher Framingham score (1.96 [+ or -] 2.74 vs. 1.09 [+ or -] 0.41, U value 1987.5FNx01, P < 0.05). Conclusion: Patients of schizophrenia have a high prevalence of MS and CVR factors. Hence, there is a need to screen the patient of schizophrenia for the same and manage the same as early as possible during the course of illness.


Several studies suggest that patients with serious mental illness die about 20 years earlier than the general population, [sup][1],[2],[3] with cardiovascular disease being the leading cause of mortality in patients with schizophrenia. [sup][2],[3],[4],[5],[6] A population-based study in a nationally representative sample from United States reported two-fold increase in the risk of mortality in persons with mental disorders, with an average life span of 8.2 years less than the rest of the population, with the majority of deaths (95.4%) attributed to medical causes rather than unnatural causes. [sup][7] Relative risk of all-cause mortality for patients with schizophrenia has been reported to be 2.6. [sup][8]

Poor health status, socioeconomic deprivation, adverse health behaviors, and poor quality of medical care are important factors associated with high mortality in subjects with severe mental illness. [sup][1] Despite this these patients usually receive inconsistent and insufficient physical monitoring and management. [sup][8]

Recently, some studies have assessed the prevalence of cardiovascular risk (CVR) factors in patients with schizophrenia and have calculated the 10-year risk of having a cardiovascular event using various parameters such as Framingham risk equation score [sup][9],[10] and systematic coronary risk evaluation (SCORE) function indicating 10-year cardiovascular mortality risk (CMR). [sup][11] The Framingham risk equation score, provides a validated calculation of 10-year risk of development of coronary heart disease (CHD) [sup][9],[10] and the SCORE function indicates the 10-year CMR. [sup][11] Recognition of these factors is emphasized as these are modifiable risk factors, which if identified and managed properly in time can contribute to a reduction in cardiovascular mortality.

Few studies have assessed the future risk of cardiovascular events in the patient of schizophrenia. Correll et al . [sup][12] reported a 10-year CHD risk of 6.5% for inpatients with schizophrenia ( n = 111). They also reported that 23.4% of patients with schizophrenia had a CHD risk more than equal to 10%. In the Clinical Antipsychotic Trials of Intervention Effectiveness study, it was observed that patients with schizophrenia had significantly higher 10-year risk of CHD than the general population (9.4% vs. 6.3% in males and 7% vs. 4.2% in females). [sup][13] These findings were replicated in a later study too. [sup][14] Other studies reported 10-year CHD risk of 6.5-7.2% and CMR to be 0.9% in patient with schizophrenia [sup][12],[15] with high/very high risk of CHD (≥10%) in 22-23% patients with schizophrenia [sup][12],[15] and high CMR risk (≥5%) in 6. …

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