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. 2018 Dec 1;75(12):1234-1240.
doi: 10.1001/jamapsychiatry.2018.2742.

Association of Secondary Preventive Cardiovascular Treatment After Myocardial Infarction With Mortality Among Patients With Schizophrenia

Pirathiv Kugathasan  1   2 , Henriette Thisted Horsdal  3 , Jørgen Aagaard  1   2 , Svend Eggert Jensen  2   4 , Thomas Munk Laursen  3 , René Ernst Nielsen  1   2
Affiliations

Association of Secondary Preventive Cardiovascular Treatment After Myocardial Infarction With Mortality Among Patients With Schizophrenia

Pirathiv Kugathasan et al. JAMA Psychiatry. .

Erratum in

  • Typographical Error in Discussion.
    [No authors listed] [No authors listed] JAMA Psychiatry. 2019 Jun 1;76(6):659. doi: 10.1001/jamapsychiatry.2019.0990. JAMA Psychiatry. 2019. PMID: 31042292 Free PMC article. No abstract available.

Abstract

Importance: Cardioprotective medication use is an important secondary preventive treatment after cardiovascular events. Patients with schizophrenia have excess cardiovascular morbidity and mortality, but no studies have investigated whether taking recommended cardioprotective medication can reduce this excess mortality.

Objective: To assess the association of exposure to secondary cardiovascular treatment with all-cause mortality after myocardial infarction among patients with schizophrenia compared with the general population.

Design, setting, and participants: This nationwide cohort study included individuals admitted with first-time myocardial infarction in Denmark from January 1, 1995, to December 31, 2015. The cohort was dichotomously divided by a diagnosis of schizophrenia. Data on the prescription of guideline-recommended cardioprotective medication, including antithrombotics, β-blockers, vitamin K antagonist, angiotensin-converting enzyme inhibitors, and statins, were obtained from the nationwide registries.

Exposures: Time exposed to cardioprotective medication.

Main outcomes and measure: Cox proportional hazards regression was used to calculate hazard ratios (HRs) with 95% CIs for the association between treatment exposure and all-cause mortality after myocardial infarction between patients with and without schizophrenia.

Results: The cohort included 105 018 patients with myocardial infarction, including 684 patients with schizophrenia (0.7%; 483 male [70.6%]; mean [SD] age at diagnosis, 57.3 [10.6] years) and 104 334 general population patients (99.3%; 73 454 male [70.4%]; mean [SD] age at diagnosis, 61.0 [10.6] years), with a total follow-up of 796 435 person-years and 28 059 deaths. Patients diagnosed with schizophrenia who did not receive cardioprotective treatment had the highest mortality rate (HR, 8.78; 95% CI, 4.37-17.64) compared with the general population treated, with treated patients diagnosed with schizophrenia having an increased HR of 1.97 (95% CI, 1.25-3.10). The analyses of the associations of different cardiac therapy strategies with mortality rates revealed that patients with schizophrenia who were treated with any combination of triple therapy had mortality rates similar to those observed in the general population (HR, 1.05; 95% CI, 0.43-2.52) in the multivariable analysis.

Conclusions and relevance: Cardioprotective medication after myocardial infarction should be carefully managed to improve prognosis. The study results suggest that some of the increased cardiac mortality among patients with schizophrenia can be reduced if these patients are efficiently administered combinations of secondary preventive treatments after cardiac events.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Nielsen reported receiving research grants from H. Lundbeck and Otsuka Pharmaceuticals for clinical trials; receiving speaking fees from Bristol-Myers Squibb, AstraZeneca, Janssen & Cilag, Lundbeck, Servier, Otsuka Pharmaceuticals, and Eli Lilly and Company; and acting as adviser to AstraZeneca, Eli Lilly and Company, Lundbeck, Otsuka Pharmaceuticals, Takeda, and Medivir. No other disclosures were reported.

Comment in

References

    1. Murray CJL, Barber RM, Foreman KJ, et al. ; GBD 2013 DALYs and HALE Collaborators . Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. Lancet. 2015;386(10009):2145-2191. doi:10.1016/S0140-6736(15)61340-X - DOI - PMC - PubMed
    1. Roth GA, Forouzanfar MH, Moran AE, et al. . Demographic and epidemiologic drivers of global cardiovascular mortality. N Engl J Med. 2015;372(14):1333-1341. doi:10.1056/NEJMoa1406656 - DOI - PMC - PubMed
    1. Korhonen MJ, Robinson JG, Annis IE, et al. . Adherence tradeoff to multiple preventive therapies and all-cause mortality after acute myocardial infarction. J Am Coll Cardiol. 2017;70(13):1543-1554. doi:10.1016/j.jacc.2017.07.783 - DOI - PMC - PubMed
    1. Jayatilleke N, Hayes RD, Dutta R, et al. . Contributions of specific causes of death to lost life expectancy in severe mental illness. Eur Psychiatry. 2017;43:109-115. doi:10.1016/j.eurpsy.2017.02.487 - DOI - PubMed
    1. Correll CU, Solmi M, Veronese N, et al. . Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry. 2017;16(2):163-180. doi:10.1002/wps.20420 - DOI - PMC - PubMed

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