Lee You-Bin, Kim Hyewon, Lee Jungkuk, Kang Dongwoo, Kim Gyuri, Jin Sang-Man, Kim Jae Hyeon, Jeon Hong Jin, Hur Kyu Yeon
Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Psychiatry, Hanyang University Hospital, Seoul, Korea.
Diabetes Metab J. 2024 Jan;48(1):122-133. doi: 10.4093/dmj.2022.0431. Epub 2024 Jan 3.
The effects of psychotic disorders on cardiometabolic diseases and premature death need to be determined in Asian populations.
In this population-based matched cohort study, the Korean National Health Insurance Service database (2002 to 2018) was used. The risk of type 2 diabetes mellitus (T2DM), acute myocardial infarction (AMI), ischemic stroke, composite of all cardiometabolic diseases, and all-cause death during follow-up was compared between individuals with psychotic disorders treated with antipsychotics (n=48,162) and 1:1 matched controls without psychiatric disorders among adults without cardiometabolic diseases before or within 3 months after baseline.
In this cohort, 53,683 composite cases of all cardiometabolic diseases (during median 7.38 years), 899 AMI, and 1,216 ischemic stroke cases (during median 14.14 years), 7,686 T2DM cases (during median 13.26 years), and 7,092 deaths (during median 14.23 years) occurred. The risk of all outcomes was higher in subjects with psychotic disorders than matched controls (adjusted hazard ratios [95% confidence intervals]: 1.522 [1.446 to 1.602] for T2DM; 1.455 [1.251 to 1.693] for AMI; 1.568 [1.373 to 1.790] for ischemic stroke; 1.595 [1.565 to 1.626] for composite of all cardiometabolic diseases; and 2.747 [2.599 to 2.904] for all-cause mortality) during follow-up. Similar patterns of associations were maintained in subgroup analyses but more prominent in younger individuals (P for interaction <0.0001) when categorized as those aged 18-39, 40-64, or ≥65 years.
Patients with psychotic disorders treated with antipsychotics were associated with increased risk of premature allcause mortality and cardiometabolic outcomes in an Asian population. This relationship was more pronounced in younger individuals, especially aged 18 to 39 years.
需要在亚洲人群中确定精神障碍对心脏代谢疾病和过早死亡的影响。
在这项基于人群的匹配队列研究中，使用了韩国国民健康保险服务数据库（2002年至2018年）。比较了在基线前或基线后3个月内无心脏代谢疾病的成年人中，接受抗精神病药物治疗的精神障碍患者（n = 48,162）与1:1匹配的无精神障碍对照者在随访期间患2型糖尿病（T2DM）、急性心肌梗死（AMI）、缺血性中风、所有心脏代谢疾病综合病症以及全因死亡的风险。
在该队列中，发生了53,683例所有心脏代谢疾病的综合病例（中位时间7.38年）、899例AMI以及1,216例缺血性中风病例（中位时间14.14年）、7,686例T2DM病例（中位时间13.26年）和7,092例死亡（中位时间14.23年）。在随访期间，精神障碍患者发生所有结局的风险均高于匹配对照者（调整后风险比[95%置信区间]：T2DM为1.522[1.446至1.602]；AMI为1.455[1.251至1.693]；缺血性中风为1.568[1.373至1.790]；所有心脏代谢疾病综合病症为1.595[1.565至1.626]；全因死亡率为2.747[2.599至2.904]）。在亚组分析中保持了相似的关联模式，但在按年龄分为18 - 39岁、40 - 64岁或≥65岁的人群中，在较年轻个体中更为显著（交互作用P<0.0001）。
在亚洲人群中，接受抗精神病药物治疗的精神障碍患者全因过早死亡和心脏代谢结局的风险增加。这种关系在较年轻个体中更为明显，尤其是18至39岁的人群。
