Increasing global burden of cardiovascular in general populations and patients with schizophrenia

Department of Biomedical Sciences, Center of Excellence, Florida Atlantic University, Boca Raton
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 02/2007; 68 Suppl 4:4-7.
Source: PubMed


Cardiovascular disease (CVD), which includes coronary heart, cerebrovascular, and peripheral vascular disease, is the leading cause of death in the United States and most developed countries, accounting for about 50% of all deaths. The major risk factors include obesity and its consequences, dyslipidemia, hypertension, insulin resistance leading to diabetes, and cigarette smoking. In developing countries, CVD will become the leading cause of death due to alarming increases in obesity, sedentary lifestyles, cigarette smoking, and improvements in prevention and treatment of malnutrition and infection. Compared with nonschizophrenics, patients with schizophrenia have a 20% shorter life expectancy (i.e., from 76 to 61 years). In general populations, about 1% die from suicide compared with about 10% among patients with schizophrenia (relative risk = 10). For CVD, the corresponding figures are 50% and about 75% (relative risk = 1.5). In patients with schizophrenia, however, CVD occurs more frequently and accounts for more premature deaths than suicide. Patients with schizophrenia have alarmingly higher rates of obesity, dyslipidemia, hypertension, diabetes, and cigarette smoking than nonschizophrenic individuals in the general population. Compounding these data, patients with schizophrenia have less access to medical care, consume less medical care, and are less compliant. Primary prevention strategies should include the choice of antipsychotic drug regimens that do not adversely affect the major risk factors for CVD.

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    • "It is recognized that individuals suffering from schizophrenia have a greater prevalence of the metabolic syndrome (De Hert, Dekker et al. 2009, De Hert, Schreurs et al. 2009, Mitchell, Vancampfort et al. 2013), and premature mortality (Saha et al., 2007, McGrath et al., 2008) with a reduced life expectancy of about 20% compared with the general population (Newman and Bland 1991; Hausswolff-Juhlin et al., 2009). The leading natural cause of death in patients with schizophrenia is cardiovascular disease (Hennekens 2006; Brown et al., 2010). However, the cause-effect relationships in this context are not straightforward (Hausswolff-Juhlin, Bjartveit et al. 2009). "
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    ABSTRACT: Method: We collected MRI structural scans in 14 first-episode schizophrenia patients with either self-reported low or high physical activity levels. We found a reduction in total gray matter volume, prefrontal cortex (PFC), and hippocampal gray matter volumes in the low physical activity group compared to the high activity group. Cortical thickness in the dorsolateral and orbitofrontal PFC were also significantly reduced in the low physical activity group compared to the high activity group. In the combined sample, greater overall physical activity levels showed a non-significant tendency with better performance on tests of verbal memory and social cognition. Together these pilot study findings suggest that greater amounts of physical activity may have a positive influence on brain health and cognition in first-episode schizophrenia patients and support the implementation of physical exercise interventions in this patient population to improve brain plasticity and cognitive functioning. (JINS, 2015, 21, 868-879).
    Journal of the International Neuropsychological Society 11/2015; 21(10):868-879. DOI:10.1017/S1355617715000983 · 2.96 Impact Factor
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    • "–68% of the patients (Culver et al., 2007; Keitner et al., 1996) and is burdened by significant side effects, such as contributing to one′s risk of cardiovascular disease (De Almeida et al., 2012; Ketter, 2010; Serretti et al., 2013). This is particularly concerning as individuals with bipolar disorder are already at a higher risk for cardiovascular disease (Khot et al., 2003; Krishnan, 2005; McIntyre et al., 2005; Soreca et al., 2008) compared to the general population, which leads to comparatively higher rates of morbidity and mortality (Angst et al., 2002; Hennekens, 2007; Osby et al., 2001). Thus, there is a need to not only improve the treatment of bipolar symptoms but also to reduce their disproportionate medical burden. "
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    ABSTRACT: Individuals with bipolar disorder lead a sedentary lifestyle associated with worse course of illness and recurrence of symptoms. Identifying potentially modifiable predictors of exercise frequency could lead to interventions with powerful consequences on the course of illness and overall health. The present study examines baseline reports of exercise frequency of bipolar patients in a multi-site comparative effectiveness study of a second generation antipsychotic (quetiapine) versus a classic mood stabilizer (lithium). Demographics, quality of life, functioning, and mood symptoms were assessed. Approximately 40% of participants reported not exercising regularly (at least once per week). Less frequent weekly exercise was associated with higher BMI, more time depressed, more depressive symptoms, and lower quality of life and functioning. In contrast, more frequent exercise was associated with experiencing more mania in the past year and more current manic symptoms. Exercise frequency was measured by self-report and details of the exercise were not collected. Analyses rely on baseline data, allowing only for association analyses. Directionality and predictive validity cannot be determined. Data were collected in the context of a clinical trial and thus, it is possible that the generalizability of the findings could be limited. There appears to be a mood-specific relationship between exercise frequency and polarity such that depression is associated with less exercise and mania with more exercise in individuals with bipolar disorder. This suggests that increasing or decreasing exercise could be a targeted intervention for patients with depressive or mood elevation symptoms, respectively.
    Journal of Affective Disorders 08/2013; 151(2). DOI:10.1016/j.jad.2013.07.031 · 3.38 Impact Factor
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    • "Increased rates of cardio-vascular diseases (CVD) (De Hert et al., 2009, 2011a; Mitchell et al., 2011) and associated premature mortality (Hennekens, 2007; Capasso et al., 2008) have become a major concern in patients with schizophrenia. "
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    ABSTRACT: Low physical fitness has been recognised as a prominent behavioural risk factor for cardiovascular diseases (CVD), metabolic syndrome (MetS) and an independent risk factor for all-cause mortality. No studies have systematically assessed physical fitness compared with a matched health control group in patients with schizophrenia. Eighty patients with schizophrenia and 40 age-, gender- and body mass index (BMI)-matched healthy volunteers were included. All participants performed an Eurofit test battery and filled out the International Physical Activity Questionnaire. Patients additionally had a fasting metabolic laboratory screening and were assessed for psychiatric symptoms. Patients with schizophrenia demonstrated a reduced whole body balance (p<0.001), explosive leg muscle strength (p=0.003), abdominal muscular endurance (p<0.001) and running speed (p<0.001). Inactive patients scored worse on most Eurofit items than patients walking for at least 30min per day. Low physical fitness was associated with illness duration, smoking, the presence of MetS and more severe negative, depressive and cognitive symptoms. Less physically active patients who smoke and suffer from high levels of negative, depressive and/or cognitive symptoms might benefit from specific rehabilitation interventions aimed at increasing physical fitness.
    Psychiatry Research 10/2012; DOI:10.1016/j.psychres.2012.09.026 · 2.47 Impact Factor
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