Chancellor's Fellow, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK.
Principal Information Analyst, Information Services Division, National Services Scotland, NHS Scotland, Scotland, UK.
Br J Psychiatry. 2020 Aug;217(2):442-449. doi: 10.1192/bjp.2019.250.
Psychiatric disorders are associated with increased risk of ischaemic heart disease (IHD) and stroke, but it is not known whether the associations or the role of sociodemographic factors have changed over time.
To investigate the association between psychiatric disorders and IHD and stroke, by time period and sociodemographic factors.
We used Scottish population-based records from 1991 to 2015 to create retrospective cohorts with a hospital record for psychiatric disorders of interest (schizophrenia, bipolar disorder or depression) or no record of hospital admission for mental illness. We estimated incidence and relative risks of IHD and stroke in people with versus without psychiatric disorders by calendar year, age, gender and area-based deprivation level.
In all cohorts, incidence of IHD (645 393 events) and stroke (276 073 events) decreased over time, but relative risks decreased for depression only. In 2015, at the mean age at event onset, relative risks were 2- to 2.5-fold higher in people with versus without a psychiatric disorder. Age at incidence of outcome differed by cohort, gender and socioeconomic status. Relative but not absolute risks were generally higher in women than men. Increasing deprivation conveys a greater absolute risk of IHD for people with bipolar disorder or depression.
Despite declines in absolute rates of IHD and stroke, relative risks remain high in those with versus without psychiatric disorders. Cardiovascular disease monitoring and prevention approaches may need to be tailored by psychiatric disorder and cardiovascular outcome, and be targeted, for example, by age and deprivation level.
精神障碍与缺血性心脏病（IHD）和中风的风险增加有关，但尚不清楚这些关联或社会人口因素的作用是否随时间而变化。
通过时间和社会人口因素来研究精神障碍与 IHD 和中风之间的关联。
我们使用了苏格兰基于人群的记录，从 1991 年到 2015 年，创建了有兴趣的精神障碍（精神分裂症、双相情感障碍或抑郁症）住院记录或无精神疾病住院记录的回顾性队列。我们按日历年度、年龄、性别和基于区域的贫困程度，估计了有和没有精神障碍的人患 IHD 和中风的发病率和相对风险。
在所有队列中，IHD（645393 例）和中风（276073 例）的发病率随时间下降，但只有抑郁症的相对风险下降。在 2015 年，在发病年龄的平均值上，与没有精神障碍的人相比，有精神障碍的人的相对风险高出 2 到 2.5 倍。发病的队列、性别和社会经济地位不同，发病年龄也不同。相对风险而非绝对风险通常在女性中高于男性。社会经济地位越高，双相情感障碍或抑郁症患者患 IHD 的绝对风险越高。
尽管 IHD 和中风的绝对发生率下降，但与没有精神障碍的人相比，有精神障碍的人的相对风险仍然很高。心血管疾病监测和预防方法可能需要根据精神障碍和心血管结局进行调整，例如按年龄和贫困程度进行调整。
