Cardiovascular Risks in Schizophrenics: What Are They Related To and How To Eliminate Them?
Schizophrenia affects about 1% of the population. This disease is associated, among other things, with increased cardiovascular (CV) morbidity and mortality. What is the cause and what to focus on in primary prevention?
Introduction
Patients with schizophrenia have a life expectancy that is 10–18 years shorter compared to the general population. The main cause of death is cardiovascular diseases (ischemic heart disease, stroke, and congestive heart failure), which account for up to two-thirds of deaths in schizophrenics (2).
According to studies, the most common risk factors (RF) are dyslipidemia (61%), smoking (55%), obesity (41%), diabetes mellitus (19%), and hypertension (17%) (1). Besides lifestyle (eating habits and insufficient physical activity), increasing CV risk can also be attributed to social deprivation or problematic communication between the patient and the doctor, along with the patient's non-compliance. Adequate primary prevention often does not occur even after these RFs are detected. Additionally, the cardiometabolic side effects of antipsychotics, such as weight gain and dyslipidemia, should be mentioned.
What Do Existing Studies Say?
Several studies have already dealt with cardiovascular risks in schizophrenics.
One meta-analysis (1) compared the 10-year CV risk in patients with schizophrenia and in patients with depression. The Framingham Risk Score (FRS), which takes into account age, gender, smoking, systolic blood pressure, and total cholesterol level, was used for estimation. Higher CV risk was observed in patients with schizophrenia (FRS 5.8−14.0) than in patients with depression (FRS 4.7−11.9).
Another study (3) used the same score to analyze CV risk in the context of positive and negative symptoms of schizophrenia. The 10-year CV risk was 5.16% in schizophrenics compared to 3.02% in the control group (p = 0.03). No connection was found between FRS and the negative and positive symptoms. However, the score significantly correlated with age, number of hospitalizations, and duration of the disease (r = 0.300; 0.261; 0.252). Higher scores were also observed in patients treated with antipsychotics (p = 0.008). Conversely, lower scores were observed with higher concentrations of HDL cholesterol in the blood (p = 0.048). Patients treated with one antipsychotic generally had higher HDL cholesterol concentrations and lower FRS than patients taking ≥ 2 antipsychotics.
Conclusion
The management of patients with schizophrenia should focus not only on psychotic symptoms but also on cardiovascular and metabolic disorders, whether related to treatment or not. It is necessary to focus on the patient's lifestyle and, in collaboration with other specialists, treat possible metabolic comorbidities within the primary prevention of CV diseases. Equally important is the choice of antipsychotic.
One of the drugs with a low risk of cardiometabolic side effects is lurasidone. It belongs to atypical antipsychotics from the SDA group (serotonin and dopamine receptor antagonists) and is indicated for the treatment of schizophrenia in adults and adolescents aged 13 years and older. According to available data, 95% of patients treated with this drug did not experience a clinically significant change in body weight (defined as a change of ≥ 7% after 6 weeks of use).
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Sources:
1. Foguet-Boreu Q., San Marin M. I. F., Mateo G. F. et al. Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis. BMC Psychiatry 2016; 16: 141, doi: 10.1186/s12888-016-0833-6.
2. Ratna V. V. J., Vempadapu M., Kolakota R. K. et al. Risk of cardiovascular disease in schizophrenia: a mini review. AJPSci 2019; 9 (2): 131–136, doi: 10.5958/2231-5659.2019.00019.5.
3. Kilicaslan E. E., Karakilic M., Erol A. The relationship between 10 years risk of cardiovascular and schizophrenia symptoms: preliminary results. Psychiatry Investig 2019; 16 (12): 933–939, doi: 13.30773/pi.2019.0063.
4. Latuda. Available at: www.latuda.com/bpd/about-latuda.html
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