Heart disease

How is heart disease related to schizophrenia?

People with schizophrenia may show increased rates of co-occurring conditions, including heart disease. It is unclear if any increased risk is a consequence of the metabolic impact of antipsychotic administration or unhealthy lifestyle choices, or most likely, a combination of both.

What is the evidence for comorbid heart disease?

Moderate quality evidence finds small increases in rates of coronary heart disease and congestive heart failure in people with schizophrenia, with rates gained from both longitudinal and cross-sectional studies, and from data adjusted for potential confounding factors. Longitudinal studies with adjusted data also show small to medium-sized increases in rates of cardiovascular disease and death due to cardiovascular disease in people with schizophrenia. Moderate to low quality evidence finds a medium-sized effect of increased risk of myocardial infarction in patients taking antipsychotics compared to those not taking antipsychotics.

Moderate quality evidence suggests rates of myocarditis and cardiomyopathy are similar in people taking clozapine, with incidence of myocarditis 0.6% and cardiomyopathy 0.7%.

Moderate to high quality evidence finds a large effect of reduced overall heart rate variability in people with schizophrenia. Chronic patients show a larger effect size than first-episode patients for reduced high-frequency heart rate variability, while first-episode patients showed a larger effect size for reduced root mean square of successive R-R interval differences RMSSD.

Moderate quality evidence finds cardiac patients with schizophrenia may be less likely to have a cardiac procedure, including revascularisation, angiogram or reperfusion than cardiac patients without schizophrenia. A small effect shows cardiac patients with schizophrenia may also be less likely to be prescribed an angiotensin converting enzyme/ angiotensin receptor blocker.

October 2020

Last updated at: 3:34 am, 19th October 2020
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