Correll Christoph U, Solmi Marco, Veronese Nicola, Bortolato Beatrice, Rosson Stella, Santonastaso Paolo, Thapa-Chhetri Nita, Fornaro Michele, Gallicchio Davide, Collantoni Enrico, Pigato Giorgio, Favaro Angela, Monaco Francesco, Kohler Cristiano, Vancampfort Davy, Ward Philip B, Gaughran Fiona, Carvalho André F, Stubbs Brendon
Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA.
World Psychiatry. 2017 Jun;16(2):163-180. doi: 10.1002/wps.20420.
People with severe mental illness (SMI) - schizophrenia, bipolar disorder and major depressive disorder - appear at risk for cardiovascular disease (CVD), but a comprehensive meta-analysis is lacking. We conducted a large-scale meta-analysis assessing the prevalence and incidence of CVD; coronary heart disease; stroke, transient ischemic attack or cerebrovascular disease; congestive heart failure; peripheral vascular disease; and CVD-related death in SMI patients (N=3,211,768) versus controls (N=113,383,368) (92 studies). The pooled CVD prevalence in SMI patients (mean age 50 years) was 9.9% (95% CI: 7.4-13.3). Adjusting for a median of seven confounders, patients had significantly higher odds of CVD versus controls in cross-sectional studies (odds ratio, OR=1.53, 95% CI: 1.27-1.83; 11 studies), and higher odds of coronary heart disease (OR=1.51, 95% CI: 1.47-1.55) and cerebrovascular disease (OR=1.42, 95% CI: 1.21-1.66). People with major depressive disorder were at increased risk for coronary heart disease, while those with schizophrenia were at increased risk for coronary heart disease, cerebrovascular disease and congestive heart failure. Cumulative CVD incidence in SMI patients was 3.6% (95% CI: 2.7-5.3) during a median follow-up of 8.4 years (range 1.8-30.0). Adjusting for a median of six confounders, SMI patients had significantly higher CVD incidence than controls in longitudinal studies (hazard ratio, HR=1.78, 95% CI: 1.60-1.98; 31 studies). The incidence was also higher for coronary heart disease (HR=1.54, 95% CI: 1.30-1.82), cerebrovascular disease (HR=1.64, 95% CI: 1.26-2.14), congestive heart failure (HR=2.10, 95% CI: 1.64-2.70), and CVD-related death (HR=1.85, 95% CI: 1.53-2.24). People with major depressive disorder, bipolar disorder and schizophrenia were all at increased risk of CVD-related death versus controls. CVD incidence increased with antipsychotic use (p=0.008), higher body mass index (p=0.008) and higher baseline CVD prevalence (p=0.03) in patients vs.
Moreover, CVD prevalence (p=0.007), but not CVD incidence (p=0.21), increased in more recently conducted studies. This large-scale meta-analysis confirms that SMI patients have significantly increased risk of CVD and CVD-related mortality, and that elevated body mass index, antipsychotic use, and CVD screening and management require urgent clinical attention.
患有严重精神疾病（SMI）——精神分裂症、双相情感障碍和重度抑郁症——的人群似乎有患心血管疾病（CVD）的风险，但缺乏全面的荟萃分析。我们进行了一项大规模荟萃分析，评估CVD、冠心病、中风、短暂性脑缺血发作或脑血管疾病、充血性心力衰竭、外周血管疾病以及SMI患者（N = 3,211,768）与对照人群（N = 113,383,368）（92项研究）中与CVD相关的死亡的患病率和发病率。SMI患者（平均年龄50岁）的合并CVD患病率为9.9%（95%置信区间：7.4 - 13.3）。在横断面研究中，校正中位数为7个混杂因素后，患者患CVD的几率显著高于对照人群（优势比，OR = 1.53，95%置信区间：1.27 - 1.83；11项研究），患冠心病（OR = 1.51，95%置信区间：1.47 - 1.55）和脑血管疾病（OR = 1.42，95%置信区间：1.21 - 1.66）的几率也更高。患有重度抑郁症的人群患冠心病的风险增加，而患有精神分裂症的人群患冠心病、脑血管疾病和充血性心力衰竭的风险增加。在中位随访8.4年（范围1.8 - 30.0）期间，SMI患者的累积CVD发病率为3.6%（95%置信区间：2.7 - 5.3）。在纵向研究中，校正中位数为6个混杂因素后，SMI患者的CVD发病率显著高于对照人群（风险比，HR = 1.78，95%置信区间：1.60 - 1.98；31项研究）。冠心病（HR = 1.54，95%置信区间：1.30 - 1.82）、脑血管疾病（HR = 1.64，95%置信区间：1.26 - 2.14）、充血性心力衰竭（HR = 2.10，95%置信区间：1.64 - 2.70）以及与CVD相关的死亡（HR = 1.85，95%置信区间：1.53 - 2.24）的发病率也更高。与对照人群相比，患有重度抑郁症、双相情感障碍和精神分裂症的人群发生与CVD相关死亡的风险均增加。与对照人群相比，患者中CVD发病率随抗精神病药物使用（p = 0.008）、较高的体重指数（p = 0.008）和较高的基线CVD患病率（p = 0.03）而增加。此外，在最近开展的研究中，CVD患病率（p = 0.007）增加，但CVD发病率（p = 0.21）未增加。这项大规模荟萃分析证实，SMI患者患CVD及与CVD相关死亡率显著增加，体重指数升高、抗精神病药物使用以及CVD筛查和管理需要临床给予紧急关注。
