精神分裂症患者心血管疾病生活方式风险因素的横断面研究。
Cardiovascular disease lifestyle risk factors in people with psychosis: a cross-sectional study.
机构信息
Faculty Health and Medicine, The University of Newcastle, Callaghan, 2308, Australia.
Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton, 2305, Australia.
出版信息
BMC Public Health. 2018 Jun 15;18(1):742. doi: 10.1186/s12889-018-5649-5.
BACKGROUND
People with psychosis die on average 25 years earlier than those in the general population, with cardiovascular disease (CVD) contributing to much of the excess mortality. This cross-sectional study aimed to identify the relationship between lifestyle risk factors for CVD - poor nutrition, smoking and low physical activity levels - and dyslipidaemia, hypertension and hyperglycaemia while controlling for potential confounders in 1825 people from the Survey of High Impact Psychosis (SHIP) in Australia. We also aimed to identify clustering patterns of lifestyle risk factors and associated demographic variables.
METHODS
Three logistic regressions were used to predict the effect of nutrition, smoking and physical activity on dyslipidaemia, hypertension and hyperglycaemia while controlling for clozapine use, sex and age. Clustering patterns of nutrition, smoking and physical activity were examined using the two-step cluster method which is based on hierarchical cluster analysis. Demographic variables associated with different clusters were identified using measures of association.
RESULTS
Smoking status had a positive association with dyslipidaemia (adjusted odds ratio = 0.50; 95% confidence interval = 0.32-0.78; p = 0.002). Other cardiovascular disease lifestyle risk factors did not have a significant relationship with dyslipidaemia, hypertension and hyperglycaemia. Clustering patterns of lifestyle risk factors showed that younger men, with low education levels, and relying on a government pension, were most likely to display the poorest lifestyle risk behaviours. The largest cluster (42%) of participants was characterised by a mixed demographic profile and were most likely to display poor nutrition and low physical activity levels but less likely to smoke.
CONCLUSIONS
Only smoking status had a significant positive association with dyslipidaemia which could indicate that there are additional factors affecting the relationship between other cardiovascular lifestyle risk factors and dyslipidaemia, hypertension and hyperglycaemia in people with psychosis. Unknown confounders and traditional lifestyle risk factors may explain the high rates of CVD in this group. Clustering of lifestyle risk factors and their demographic profiles could help the design of intervention programs in people with psychosis.
背景
患有精神病的人比普通人群平均早逝 25 年，心血管疾病（CVD）是导致大部分超额死亡率的主要原因。本横断面研究旨在通过澳大利亚调查高影响力精神病学（SHIP）的 1825 名患者，确定 CVD 的生活方式风险因素（包括营养不良、吸烟和低体力活动水平）与血脂异常、高血压和高血糖之间的关系，同时控制潜在的混杂因素。我们还旨在确定生活方式风险因素及其相关人口统计学变量的聚类模式。
方法
使用三个逻辑回归来预测营养、吸烟和体力活动对血脂异常、高血压和高血糖的影响，同时控制氯氮平的使用、性别和年龄。使用基于层次聚类分析的两步聚类方法来检查营养、吸烟和体力活动的聚类模式。使用关联度量来确定与不同聚类相关的人口统计学变量。
结果
吸烟状况与血脂异常呈正相关（调整后的优势比=0.50；95%置信区间=0.32-0.78；p=0.002）。其他心血管疾病生活方式风险因素与血脂异常、高血压和高血糖没有显著关系。生活方式风险因素的聚类模式表明，年轻男性、受教育程度较低、依靠政府养老金的人最有可能表现出最糟糕的生活方式风险行为。最大的聚类（42%）的参与者具有混合的人口统计学特征，最有可能表现出不良的营养和低体力活动水平，但吸烟可能性较小。
结论
只有吸烟状况与血脂异常呈显著正相关，这可能表明在精神病患者中，其他心血管生活方式风险因素与血脂异常、高血压和高血糖之间的关系存在其他因素。未知的混杂因素和传统的生活方式风险因素可能解释了该人群中 CVD 发生率较高的原因。生活方式风险因素及其人口统计学特征的聚类可能有助于为精神病患者设计干预计划。
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