Undiagnosed cardiovascular disease prior to cardiovascular death in individuals with severe mental illness

Heiberg, Ina Heidi; Jacobsen, Bjarne K.; Balteskard, Lise; Bramness, Jørgen G.; Næss, Øyvind; Ystrøm, Eivind; Reichborn‐Kjennerud, Ted; Hultman, Christina M.; Nesvåg, Ragnar; Høye, Anne

doi:10.1111/acps.13017

Cited by 55 publications

(30 citation statements)

References 82 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is contrary to most earlier research which found elevated mortality risk in both sexes (Ösby et al ., 2001 ; Crump et al ., 2013 ; Westman et al ., 2013 ; Pan et al ., 2020 ), although some revealed slightly higher cardiovascular mortality in women than in men (Ösby et al ., 2001 ; Crump et al ., 2013 ). A recent study further demonstrated that female patients with bipolar disorder were more likely to die of undiagnosed cardiovascular diseases than male counterparts (Heiberg et al ., 2019 ). Lifestyle modification, early detection and optimal treatment of comorbid diabetes, dyslipidaemia and hypertension should be implemented to reduce cardiovascular mortality in bipolar disorder.…”

Section: Discussionmentioning

confidence: 99%

Excess mortality and life-years lost in people with bipolar disorder: an 11-year population-based cohort study

Chan

Wong

Yung

et al. 2021

Epidemiol Psychiatr Sci

View full text Add to dashboard Cite

Aims Bipolar disorder is associated with premature mortality, but evidence is mostly derived from Western countries. There has been no research evaluating shortened lifespan in bipolar disorder using life-years lost (LYLs), which is a recently developed mortality metric taking into account illness onset for life expectancy estimation. The current study aimed to examine the extent of premature mortality in bipolar disorder patients relative to the general population in Hong Kong (HK) in terms of standardised mortality ratio (SMR) and excess LYLs, and changes of mortality rate over time. Methods This population-based cohort study investigated excess mortality in 12 556 bipolar disorder patients between 2008 and 2018, by estimating all-cause and cause-specific SMRs, and LYLs. Trends in annual SMRs over the 11-year study period were assessed. Study data were retrieved from a territory-wide medical-record database of HK public healthcare services. Results Patients had higher all-cause [SMR: 2.60 (95% CI: 2.45–2.76)], natural-cause [SMR: 1.90 (95% CI: 1.76–2.05)] and unnatural-cause [SMR: 8.63 (95% CI: 7.34–10.03)] mortality rates than the general population. Respiratory diseases, cardiovascular diseases and cancers accounted for the majority of deaths. Men and women with bipolar disorder had 6.78 (95% CI: 6.00–7.84) years and 7.35 (95% CI: 6.75–8.06) years of excess LYLs, respectively. The overall mortality gap remained similar over time, albeit slightly improved in men with bipolar disorder. Conclusions Bipolar disorder is associated with increased premature mortality and substantially reduced lifespan in a predominantly Chinese population, with excess deaths mainly attributed to natural causes. Persistent mortality gap underscores an urgent need for targeted interventions to improve physical health of patients with bipolar disorder.

show abstract

Section: Discussionmentioning

confidence: 99%

Excess mortality and life-years lost in people with bipolar disorder: an 11-year population-based cohort study

Chan

Wong

Yung

et al. 2021

Epidemiol Psychiatr Sci

View full text Add to dashboard Cite

show abstract

“…Compared with the general population, the risk of cardiovascular mortality is almost 2-fold in bipolar disorder and 2 to 3-fold in schizophrenia ( 3 – 5 ). Undiagnosed CVD prior to cardiovascular death is more common in psychotic disorders than in the general population ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Atherogenic Lipid Ratios Related to Myeloperoxidase and C-Reactive Protein Levels in Psychotic Disorders

et al. 2020

View full text Add to dashboard Cite

Results: A markedly higher proportion (26%-31%) of patients had increased TC/HDL and TG/HDL ratios compared with HC. Plasma levels of high-sensitivity C-reactive protein (hs-CRP) and myeloperoxidase (MPO) were higher (p<0.05, p<0.001) in patients with psychotic disorders than in HC, and hs-CRP and MPO were independently associated with atherogenic lipid ratios in the multivariable analyses. Conclusions: Our findings suggest that low-grade inflammation and abnormal neutrophil activation may cause increased CVD risk in patients with psychotic disorders. These mechanisms should be further examined to determine the potential for development of novel risk evaluation strategies.

show abstract

“…Previous studies have shown that patients with schizophrenia are more likely to receive suboptimal medical care for their physical illnesses, which has resulted in excessive mortality. [29][30][31][32][33][34] Such suboptimal medical care is due to complex reasons, possibly related to patients' decreased ability for self-care and limited access to medical service. 35,36 Evidence has suggested that the association between risk of sudden cardiac death and residence in a rural area is related to the referral rate of specialist care.…”

Section: Discussionmentioning

confidence: 99%

Age Effect on Incidence, Physical, and Psychiatric Comorbidity for Sudden Cardiac Death in Schizophrenia: Effet de l’âge sur l’incidence, la comorbidité physique et psychiatrique de la mort cardiaque subite dans la schizophrénie

et al. 2020

View full text Add to dashboard Cite

Objective: The pathogenesis of sudden cardiac death may differ between younger and older adults in schizophrenia, but evidence remains scant. This study investigated the age effect on the incidence and risk of the physical and psychiatric comorbidity for sudden cardiac death. Methods: Using 2000 to 2016 data from the Taiwan National Health Insurance Research Database and Department of Health Death Certification System, we identified a national cohort of 170,322 patients with schizophrenia, 1,836 of whom had a sudden cardiac death. Standardized mortality ratios (SMRs) were estimated. Hazard ratios and population attributable fractions of distinctive comorbidities for sudden cardiac death were assessed. Results: The SMRs of sudden cardiac death were all >1.00 across each age group for both sexes, with the highest SMR in male patients aged <35 years (30.88, 95% CI: 26.18–36.18). The fractions of sudden cardiac death attributable to hypertension and congestive heart failure noticeably increased with age. By contrast, the fraction attributable to drug-induced mental disorder decreased with age. Additionally, chronic hepatic disease and sleep disorder increased the risk of sudden cardiac death in patients aged <35 years. Dementia and organic mental disorder elevated the risk in patients aged between 35–54 years. Ischemic heart disease raised the risk in patients aged ≥55 years. Conclusions: The risk is increased across the lifespan in schizophrenia, particularly for younger male patients. Furthermore, physical and psychiatric comorbidities have age-dependent risks. The findings suggest that prevention strategies targeted toward sudden cardiac death in patients with schizophrenia must consider the age effect.

show abstract

Undiagnosed cardiovascular disease prior to cardiovascular death in individuals with severe mental illness

Cited by 55 publications

References 82 publications

Excess mortality and life-years lost in people with bipolar disorder: an 11-year population-based cohort study

Excess mortality and life-years lost in people with bipolar disorder: an 11-year population-based cohort study

Atherogenic Lipid Ratios Related to Myeloperoxidase and C-Reactive Protein Levels in Psychotic Disorders

Age Effect on Incidence, Physical, and Psychiatric Comorbidity for Sudden Cardiac Death in Schizophrenia: Effet de l’âge sur l’incidence, la comorbidité physique et psychiatrique de la mort cardiaque subite dans la schizophrénie

Contact Info

Product

Resources

About