Schizophrenia is associated with a significantly higher risk of developing cardiovascular disease (CVD), with a more pronounced relationship in women, results of a new study suggested.

METHODOLOGY:

• The observational study included 4,124,508 patients without a history of CVD, median age of 44 years, from a Japanese health claims database.
• The primary outcome was a composite of myocardial infarction (MI), angina pectoris, stroke, heart failure, atrial fibrillation, and pulmonary embolism; secondary outcomes included these individual outcomes.
• Researchers examined the association between schizophrenia and incident CVD in men and women and adjusted for age, body mass index, hypertension, diabetes, dyslipidemia, cigarette smoking, alcohol consumption, and physical inactivity in the final model.
• They performed subgroup analyses by age (≥ 50 vs < 50 years), obesity, hypertension, diabetes, dyslipidemia, and smoking, as well as a series of sensitivity analyses to validate the primary results.

TAKEAWAY:

• During a mean follow-up of 1288 days, 182,158 CVD diagnoses were recorded, with an incidence rate of 141.1 per 10,000 person-years in men and 112.0 per 10,000 person-years in women.
• Compared with those without schizophrenia, CVD risk in those with the condition was higher among women than in men (hazard ratio [HR], 1.63 vs 1.42, respectively; P = .0049), which the authors write could be attributed to hormonal changes during pregnancy and menopause or different cardiovascular risk factors such as physical inactivity in women.
• Among those with schizophrenia, HRs for individual outcomes with significant P values for men and women, respectively, included: 1.04 and 1.31 for MI; 1.33 and 1.53 for angina pectoris; 1.42 and 1.80 for heart failure; and 1.02 and 1.44 for atrial fibrillation.
• Schizophrenia was linked to an increased risk for CVD in men and women in those under 50 and those 50 and older, and results were consistent across all other subgroups in sensitivity analyses.

IN PRACTICE:

Given the findings, “healthcare providers should incorporate routine screening and treatment of schizophrenia into standard clinical practice,” the investigators wrote. Psychiatrists and cardiologists should work together to prevent CVD, especially in women, they added.

SOURCE:

The study, led by Jin Komuro, MD, Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan, was published online on February 27, 2024, in the Journal of the American Heart Association.

LIMITATIONS:

This observational study demonstrates an association between schizophrenia and CVD, not causation. The accuracy of diagnoses in insurance claims databases is uncertain, and as the database used in this study mainly includes working-age patients, it’s unclear if the findings can be generalized. The study didn’t consider variables such as socioeconomic status that may affect the relationship between schizophrenia and CVD. Individuals with schizophrenia may have had poor adherence to treatment for conditions such as hypertension and diabetes, which could have influenced the results.