Increased Framingham 10-year risk of coronary heart disease in middle-aged and older patients with psychotic symptoms

Department of Psychiatry, University of California, San Diego, CA 92161, United States.
Schizophrenia Research (Impact Factor: 3.92). 02/2011; 125(2-3):295-9. DOI: 10.1016/j.schres.2010.10.029
Source: PubMed


The Framingham 10-risk of coronary heart disease (CHD) has been a widely studied estimate of cardiovascular risk in the general population. However, few studies have compared the relative risk of developing CHD in antipsychotic-treated patients with different psychiatric disorders, especially in older patients with psychotic symptoms. In this study, we compared the 10-year risk of developing CHD among middle-aged and older patients with psychotic symptoms to that in the general population.
We analyzed baseline data from a study examining metabolic and cardiovascular effects of atypical antipsychotics in patients over age 40 with psychotic symptoms. After excluding patients with prior history of CHD and stroke, 179 subjects were included in this study. Among them, 68 had a diagnosis of schizophrenia, 42 mood disorder, 38 dementia, and 31 PTSD. Clinical evaluations included medical and pharmacologic treatment history, physical examination, and clinical labs for metabolic profiles. Using the Framingham 10-year risk of developing CHD based on the Framingham Heart Study (FHS), we calculated the risk CHD risk for each patient, and then compared relative risk in each psychiatric diagnosis to the risks reported in the FHS.
The mean age of entire sample was 63 (range 40-94) years, 68% were men. The Framingham 10-year risk of CHD was increased by 79% in schizophrenia, 72% in PTSD, 61% in mood disorder with psychosis, and 11% in dementia relative to the risk in general population from the FHS.
In this sample of middle-aged and older patients with psychotic symptoms, we found a significantly increased 10-year risk of CHD relative to the estimated risk from FHS, with the greatest increased risk for patients with schizophrenia and PTSD. Development of optimally tailored prevention and intervention efforts to decrease different risk components in these patients could be an important step to help decrease the risks of CHD and overall mortality in this vulnerable population.

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Available from: Hua Jin, Sep 29, 2015
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    • "Patients with these severe mental illnesses suffer from impairments in both activities of daily living and higher order instrumental activities of daily living, with these outcomes often impacted by cognitive deficits and motivational problems, although physical limitations may contribute (Harvey and Strassnig, 2012). Higher rates of overweight, obesity and related metabolic comorbidities compared to the mentally healthy (Hennekens et al., 2005; Homel et al., 2002; Jin et al., 2011) coincide with dyslipidemia, insulin resistance, and hyperglycemia, leading to an increased occurrence of cardiovascular disease, Type 2 diabetes mellitus, hypertension, and metabolic syndrome (Casey et al., 2004; Newcomer and Hennekens, 2007). The use of antipsychotic medications and mood stabilizers adds deleterious adipogenic and cardiometabolic risks, proliferated by poor diets, limited exercise, high rates of smoking, and low physical activity levels, all more common in SMI than the general population (Megna et al., 2011). "
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    ABSTRACT: We developed a physical exercise intervention aimed at improving multiple determinants of physical performance in severe mental illness. A sample of 12 (9M, 3F) overweight or obese community-dwelling patients with schizophrenia (n=9) and bipolar disorder (n=3) completed an eight-week, high-velocity circuit resistance training, performed twice a week on the computerized Keiser pneumatic exercise machines, including extensive pre/post physical performance testing. Participants showed significant increases in strength and power in all major muscle groups. There were significant positive cognitive changes, objectively measured with the Brief Assessment of Cognition Scale: improvement in composite scores, processing speed and symbol coding. Calgary Depression Scale for Schizophrenia and Positive and Negative Syndrome Scale total scores improved significantly. There were large gains in neuromuscular performance that have functional implications. The cognitive domains that showed the greatest improvements (memory and processing speed) are most highly predictive of disability in schizophrenia. Moreover, the improvements seen in depression suggest this type of exercise intervention may be a valuable add-on therapy for bipolar depression. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    07/2015; 229(1-2). DOI:10.1016/j.psychres.2015.07.007
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    • "The physical health status of patients with schizophrenia is extremely poor. They have higher rates of obesity and related metabolic comorbidities than the mentally healthy Hennekens et al., 2005; Homel et al., 2002; Jin et al., 2011; McEvoy et al., 2005, Dyslipidemia, insulin resistance and hyperglycemia are all more common in this population Newcomer, 2004, with similarly increased prevalence of CVD, type 2 diabetes, hypertension Casey et al., 2004, and metabolic syndrome Newcomer, 2007. Health status-related mortality shortens the lifespan of people with schizophrenia by 25 years on average Hennekens et al., 2005. "
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    ABSTRACT: Despite 50 years of pharmacological and psychosocial interventions, schizophrenia remains one of the leading causes of disability. Schizophrenia is also a life-shortening illness, caused mainly by poor physical health and its complications. The end result is a considerably reduced lifespan that is marred by reduced levels of independence, with few novel treatment options available. Disability is a multidimensional construct that results from different, and often interacting, factors associated with specific types and levels of impairment. In schizophrenia, the most poignant and well characterized determinants of disability are symptoms, cognitive and related skills deficits, but there is limited understanding of other relevant factors that contribute to disability. Here we conceptualize how reduced physical performance interacts with aging, neurobiological, treatment-emergent, and cognitive and skills deficits to exacerbate ADL disability and worsen physical health. We argue that clearly defined physical performance components represent underappreciated variables that, as in mentally healthy people, offer accessible targets for exercise interventions to improve ADLs in schizophrenia, alone or in combination with improvements in cognition and health. And, finally, due to the accelerated aging pattern inherent in this disease – lifespans are reduced by 25 years on average – we present a training model based on proven training interventions successfully used in older persons. This model is designed to target the physical and psychological declines associated with decreased independence, coupled with the cardiovascular risk factors and components of the metabolic syndrome seen in schizophrenia due to their excess prevalence of obesity and low fitness levels.
    Schizophrenia Research: Cognition 06/2014; 1(2). DOI:10.1016/j.scog.2014.06.002
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    • "Quality of life and expected survival are decreased in patients with schizophrenia because of these concomitant chronic diseases.2–5 Cardiovascular diseases, which are among the leading causes of morbidity and mortality worldwide, are more common in patients with schizophrenia; however, they usually remain underdiagnosed.6–8 Studies have shown that risk factors for cardiovascular diseases such as obesity, diabetes, metabolic syndrome, hypertension, dyslipidemia, smoking, and sedentary lifestyle are also more common in patients with schizophrenia than in the nonschizophrenic population.6,9–13 "
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    ABSTRACT: Patients with schizophrenia have a higher risk for cardiovascular diseases, which is associated with early mortality compared with the nonschizophrenic population. Early diagnosis of cardiovascular diseases in asymptomatic periods in patients with schizophrenia would enhance their quality of life and reduce mortality. Echocardiography, carotid ultrasonography, and ankle brachial index (ABI) measurement are known to be beneficial methods of detecting subclinical cardiovascular diseases and of risk stratification. The present study investigated carotid intima media thickness (CIMT) and ABI and echocardiographic parameters measured via conventional and tissue Doppler echocardiography in patients with schizophrenia in comparison with a control group. The present case-control study included 116 patients with schizophrenia and 88 healthy patients. Participants with any current comorbid psychiatric disorder, current or lifetime neurological and medical problems, current coronary artery disease, diabetes, hypertension, hypothyroidism, or hyperthyroidism or who were using antihypertensives, antidiabetic agents, or antiobesity drugs were excluded. High-resolution B-mode ultrasound images were used to measure CIMT. Conventional and tissue Doppler measurements were performed according to the recommendations of the American Society of Echocardiography. Low ABI, mitral ratio of the early (E) to late (A) ventricular filling velocities, septal E', septal S', lateral E', lateral S', septal E'/septal A', lateral E'/lateral A', and high septal A', mitral E/septal E', mitral E/lateral E', and CIMT values were observed in the schizophrenia group compared with the control group. Doppler parameters supported the hypothesis that patients with schizophrenia are at high risk for cardiovascular diseases.
    Neuropsychiatric Disease and Treatment 10/2013; 9:1531-7. DOI:10.2147/NDT.S52030 · 1.74 Impact Factor
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