Chang Jooyoung, Kim Jihoon Andrew, Kim Kyuwoong, Choi Seulggie, Kim Sung Min, Nam Yoon-Young, Park Subin, Goo Ae Jin, Park Sang Min
Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea.
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
Asian J Psychiatr. 2020 Aug;52:102161. doi: 10.1016/j.ajp.2020.102161. Epub 2020 May 12.
The effect of antipsychotics adherence on the risk of cardiovascular disease (CVD) among schizophrenia patients has not been studied. While antipsychotic adherence is favorable for all-cause mortality, its association with CVD incidence is unclear due to the potential risk of CVD caused by antipsychotics.
Using the Korean National Health Insurance Service Database, we constructed a case-cohort of 80,581 newly-diagnosed schizophrenia patients between 2004 and 2013 from a cohort of all Koreans 20-40 years old. Patients were divided into quartiles by adherence determined by their two-year medication possession ratio. Patients were followed from two years following the diagnosis of schizophrenia until Dec. 31st, 2017 for the primary outcome of incident CVD and secondary outcomes of stroke, myocardial infarction, and all-cause mortality. Cox proportional hazards analysis was performed adjusting for conventional risk factors.
Newly diagnosed schizophrenia patients were followed for a median of 7.0 years resulting in 1396 incident CVD cases over 5.73 × 10 person-years. When adjusted for potential confounders, the best adherence quartile group had significantly lower risk of CVD (HR, 95%CI; 0.78, 0.66-0.92; p-trend, 0.003), stroke (HR, 95%CI; 0.79, 0.66-0.94; p-trend, 0.015), and all-cause mortality (HR, 95%CI; 0.86, 0.78-0.95; p-trend, 0.003) compared to the worst adherent quartile group. Subgroup analysis by antipsychotics generation, concurrent medication, and comorbidities did not significantly alter results.
Among newly diagnosed schizophrenia patients, better adherence to antipsychotics lowered the risk CVD incidence despite previously suggested antipsychotic-associated CVD risk. Thus, efforts to improve antipsychotics adherence may improve CVD outcomes in schizophrenia patients.
尚未研究抗精神病药物依从性对精神分裂症患者心血管疾病（CVD）风险的影响。虽然抗精神病药物依从性有利于全因死亡率，但其与CVD发病率的关联尚不清楚，因为抗精神病药物可能导致CVD风险。
利用韩国国民健康保险服务数据库，我们从20至40岁的所有韩国人群队列中构建了一个包含80581名2004年至2013年新诊断精神分裂症患者的病例队列。根据患者两年的药物持有率确定的依从性将患者分为四分位数。从精神分裂症诊断后的两年开始对患者进行随访，直至2017年12月31日，观察CVD发病的主要结局以及中风、心肌梗死和全因死亡率的次要结局。进行Cox比例风险分析，并对传统风险因素进行调整。
新诊断的精神分裂症患者中位随访7.0年，在5.73×10人年期间出现1396例CVD病例。在对潜在混杂因素进行调整后，最佳依从性四分位数组的CVD风险（HR，95%CI；0.78，0.66 - 0.92；p趋势，0.003）、中风风险（HR，95%CI；0.79，0.66 - 0.94；p趋势，0.015）和全因死亡率（HR，95%CI；0.86，0.78 - 0.95；p趋势，0.003）均显著低于最差依从性四分位数组。按抗精神病药物代、联合用药和合并症进行的亚组分析未显著改变结果。
在新诊断的精神分裂症患者中，尽管先前有研究表明抗精神病药物与CVD风险相关，但更好地依从抗精神病药物可降低CVD发病风险。因此，努力提高抗精神病药物依从性可能会改善精神分裂症患者的CVD结局。
