A comprehensive cardiovascular disease risk profile in patients with schizophrenia

Abstract

Patients with schizophrenia are physically inactive and have high prevalence of cardiovascular disease (CVD). Peak oxygen uptake (V̇O2peak) is one of the strongest predictors for CVD, yet is rarely investigated in this patient population, and how V̇O2peak relates to other conventional CVD risk measures in this population is unclear. We measured treadmill V̇O2peak along with daily physical activity assessed by triaxial accelerometry, body mass index (BMI), waist circumference, blood pressure, lipid profiles, and glucose in 48 outpatients (28 men, 35 ± 10 (SD) years; 20 women, 35 ± 12 years), diagnosed with schizophrenia, schizotypal, or delusional disorders (ICD‐10; F20‐29). The patients were compared with 48 age‐ and sex‐matched healthy references (±2 years) and normative data from the population. V̇O2peak was 34.5 ± 8.7 mL/kg/min (men) and 26.4 ± 7.0 mL/kg/min (women), which was 27% and 30% lower than healthy references, respectively (both P < 0.01). V̇O2peak was not associated with daily physical activity in men while a weak association was seen in women (steps per day: r2 = 0.26; counts per minute: r2 = 0.25; P < 0.05). BMI (26.0 ± 6.1 kg/m2) revealed that patients were moderately overweight with a waist circumference of 103 ± 17 cm. Lipid‐ and glucose levels, and blood pressure were all within normative range. Our data advocate the utilization of V̇O2peak assessment for CVD risk profile determination in patients with schizophrenia. Daily physical activity was poorly and inconsistently related to V̇O2peak, suggesting increased daily physical activity might not translate into improved V̇O2peak and CVD risk reduction.

Is there an association between cardiorespiratory fitness and stage of illness in psychotic disorders? A systematic review and meta‐analysis

“…As shown in Tables and , 38 studies met criteria for inclusion in the qualitative synthesis and all were published after 2005 .…”

“…Despite methodological limitations across studies, descriptive synthesis of findings indicated that suboptimal CRF was observed in Stage 0 (offspring), Stage 1 (CHR/UHR), and Stage 2 (FEP) including evidence from incidence studies and case–control comparisons . Likewise, impaired CRF was reported in clinical samples classified as Stage 3 or 4 compared with matched HC . Many case–control studies matched groups for demographic variables known to influence CRF but not for BMI.…”

“…Twenty‐two studies reported CRF data as mean scores for VO 2 (max, peak, or predicted VO2 in ml/kg/min), and 10 of these studies included data for HC (Stage 1 = 1; Stages 1 and 2 = 1; Stage 2 = 2; Stage 3 = 5; Stage 4 = 2). Figure reports the sample sizes for each group in the 10 eligible studies, and the forest plot demonstrates the overall ES for CRF (with 95% CI) for all studies and then the ES for each clinical stage. The overall ES (shown at the bottom of the plot) highlights that CRF was significantly reduced when samples comprising of individuals classified according to stage were combined together ( N = 637) compared with the 5606 controls (random‐effects model: g = −0.93; 95% CI −1.14, −0.71).…”

“…For Stage 2, three cohort studies reported CRF in army recruits and noted an association between lower CRF and the incidence of FEP (15)(16)(17); two other studies employed a casecontrol design (8,14) and six others comprised of FEP groups only (18)(19)(20)(21)(22)(23). Nineteen studies included subgroups classified as Stage 3 (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42), of which four included a matched HC group (30)(31)(32)40) and one included a general population reference sample (39). Seven studies included subgroups classified as Stage 4 (43)(44)(45)(46)(47)(48)(49), of which two included matched HC groups (45,46).…”

Improving physical health outcomes for people with severe mental illness: A proof‐of‐concept study of nurse practitioner candidate practice

“…Despite increasing evidence of consumers’ poor physical health and efforts to prevent morbidity (Baxter et al ; Furness et al ; Hughes et al ), their mortality age is disproportionately younger compared with the general population (Correll et al ; Nemani et al ). Recognized co‐occurring physical health conditions for consumers include poor cardiovascular (Brobakken et al ), respiratory (Jørgensen et al ), and cardiometabolic (Yoca et al ) health. Lifestyle behaviours such as sub‐optimal dental hygiene (Wey et al ), unsafe sexual practices (Montejo et al ), substance misuse (Libuy et al ), and harmful diet (Firth et al ) are also linked with consumers’ premature mortality.…”