Pérez-Piñar M, Mathur R, Foguet Q, Ayis S, Robson J, Ayerbe L
The Westborough Road Health Centre, Westcliff-on-Sea, United Kingdom.
Centre for Primary Care and Public Health, Queen Mary university of London, London, United Kingdom.
Eur Psychiatry. 2016 May;35:8-15. doi: 10.1016/j.eurpsy.2016.02.004. Epub 2016 Apr 7.
The evidence informing the management of cardiovascular risk in patients with psychiatric disorders is weak.
This cohort study used data from all patients, aged≥30, registered in 140 primary care practices (n=524,952) in London to estimate the risk of developing diabetes, hypertension, hyperlipidemia, tobacco consumption, obesity, and physical inactivity, between 2005 and 2015, for patients with a previous diagnosis of schizophrenia, depression, anxiety, bipolar or personality disorder. The role of antidepressants, antipsychotics and social deprivation in these associations was also investigated. The age at detection of cardiovascular risk factor was compared between patients with and without psychiatric disorders. Variables, for exposures and outcomes, defined from general practitioners records, were analysed using multivariate regression.
Patients with psychiatric disorders had an increased risk for cardiovascular risk factors, especially diabetes, with hazard ratios: 2.42 (2.20-2.67) to 1.31 (1.25-1.37), hyperlipidemia, with hazard ratios: 1.78 (1.60-1.97) to 1.25 (1.23-1.28), and obesity. Antidepressants, antipsychotics and social deprivation did not change these associations, except for smoking and physical inactivity. Antidepressants were associated with higher risk of diabetes, hypertension and hyperlipidemia. Antipsychotics were associated with a higher risk of diabetes. Antidepressants and antipsychotics were associated with lower risk of other risk factors. Patients with psychiatric conditions have later detection of cardiovascular risk factors. The interpretation of these results should acknowledge the lower rates of detection of risk factors in mentally ill patients.
Cardiovascular risk factors require special clinical attention among patients with psychiatric disorders. Further research could study the effect of antidepressants and antipsychotics on cardiovascular risk factors.
用于指导精神疾病患者心血管疾病风险管理的证据不足。
这项队列研究使用了伦敦140家初级医疗诊所（n = 524,952）中所有年龄≥30岁的患者的数据，以估计2005年至2015年间，既往诊断为精神分裂症、抑郁症、焦虑症、双相情感障碍或人格障碍的患者患糖尿病、高血压、高脂血症、吸烟、肥胖和缺乏身体活动的风险。还研究了抗抑郁药、抗精神病药和社会剥夺在这些关联中的作用。比较了有精神疾病和无精神疾病患者心血管危险因素的发现年龄。使用多变量回归分析了从全科医生记录中定义的暴露和结局变量。
精神疾病患者患心血管危险因素的风险增加，尤其是糖尿病，风险比为2.42（2.20 - 2.67）至1.31（1.25 - 1.37），高脂血症的风险比为1.78（1.60 - 1.97）至1.25（1.23 - 1.28），以及肥胖。除了吸烟和缺乏身体活动外，抗抑郁药、抗精神病药和社会剥夺并没有改变这些关联。抗抑郁药与患糖尿病、高血压和高脂血症的较高风险相关。抗精神病药与患糖尿病的较高风险相关。抗抑郁药和抗精神病药与其他危险因素的较低风险相关。患有精神疾病的患者心血管危险因素的发现时间较晚。对这些结果的解释应考虑到精神病患者中危险因素的较低检出率。
精神疾病患者的心血管危险因素需要特别的临床关注。进一步的研究可以探讨抗抑郁药和抗精神病药对心血管危险因素的影响。
