中年及以上有精神病症状患者Framingham 10 年冠心病风险增加。
Increased Framingham 10-year risk of coronary heart disease in middle-aged and older patients with psychotic symptoms.
机构信息
Department of Psychiatry, University of California, San Diego, CA 92161, United States.
出版信息
Schizophr Res. 2011 Feb;125(2-3):295-9. doi: 10.1016/j.schres.2010.10.029. Epub 2010 Nov 19.
OBJECTIVE
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.
METHOD
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.
RESULTS
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.
CONCLUSIONS
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.
目的
弗雷明汉冠心病（CHD）10 风险已被广泛研究，用于评估普通人群的心血管风险。然而，很少有研究比较不同精神障碍的抗精神病药物治疗患者发生 CHD 的相对风险，尤其是在有精神病症状的老年患者中。在这项研究中，我们比较了有精神病症状的中年和老年患者发生 CHD 的 10 年风险与普通人群的风险。
方法
我们分析了一项研究的基线数据，该研究检查了年龄在 40 岁以上有精神病症状的患者使用非典型抗精神病药物对代谢和心血管的影响。在排除有 CHD 和中风既往史的患者后，共有 179 名患者纳入本研究。其中，68 名诊断为精神分裂症，42 名诊断为心境障碍，38 名诊断为痴呆，31 名诊断为 PTSD。临床评估包括医疗和药物治疗史、体格检查和代谢谱的临床实验室检查。使用基于弗雷明汉心脏研究（FHS）的 Framingham 10 年 CHD 发病风险，我们计算了每位患者的 CHD 风险，然后将每个精神科诊断的相对风险与 FHS 报告的风险进行比较。
结果
整个样本的平均年龄为 63 岁（范围 40-94 岁），68%为男性。与 FHS 普通人群的风险相比，精神分裂症患者的 Framingham 10 年 CHD 风险增加 79%，PTSD 患者增加 72%，有精神病症状的心境障碍患者增加 61%，痴呆患者增加 11%。
结论
在这个有精神病症状的中年和老年患者样本中，我们发现 CHD 的 10 年风险相对 FHS 估计风险显著增加，精神分裂症和 PTSD 患者的风险增加最大。制定最佳的个性化预防和干预措施来降低这些患者的不同风险因素，可能是帮助降低这一脆弱人群 CHD 和总死亡率风险的重要步骤。
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