Risk of Cardiovascular Disease Hospitalization After Common Psychiatric Disorders: Analyses of Disease Susceptibility and Progression Trajectory in the UK Biobank

Abstract

Whether associations between psychiatric disorders and hospitalization for cardiovascular diseases (CVDs) can be modified by disease susceptibility and the temporal pattern of these associated CVDs remain unknown. In our study, we conducted a matched cohort study of the UK Biobank including 44,430 patients with common psychiatric disorders (anxiety, depression, and stress-related disorders) between 1997 and 2019, together with 222,150 sex-, Townsend deprivation index-, and birth year- individually matched unexposed individuals. The hazard ratios (HRs) for CVD hospitalization associated with a prior psychiatric disorder were derived from Cox models, adjusted for multiple confounders. We then stratified the analyses by self-reported family history of CVD and CVD polygenic risk score (PRS) calculated based on summary statistics of independent genome-wide association studies. We further conducted disease trajectory analysis and visualized the temporal pattern of CVDs after common psychiatric disorders. During a mean follow-up of 12.28 years, we observed an elevated risk of CVD hospitalization among patients with psychiatric disorders, compared with matched unexposed individuals (hazard ratios [HRs] = 1.20, 95% confidence interval [CI]: 1.18-1.23), especially during the first six months of follow-up (1.72 [1.55-1.91]). The stratification analyses by family history of CVD and by CVD PRS obtained similar estimates between subgroups with different susceptibilities to CVD. We conducted trajectory analysis to visualize the temporal pattern of CVDs after common psychiatric disorders, identifying primary hypertension, acute myocardial infarction, and stroke as three main intermediate steps leading to further increased risk of other CVDs. In conclusion, the association between common psychiatric disorders and subsequent CVD hospitalization is not modified by predisposition to CVD. Hypertension, acute myocardial infarction, and stroke are three initial CVDs linking psychiatric disorders to other CVD sequelae, highlighting a need of timely intervention on these targets to prevent further CVD sequelae among all individuals with common psychiatric disorders.

Supplementary information: The online version contains supplementary material available at 10.1007/s43657-023-00134-w.

Keywords: Cardiovascular disease; Disease susceptibility; Disease trajectory; Psychiatric disorders.

Fig. 1

Flowchart of the participants' selection. This figure shows the study design, and the inclusion and exclusion process of study population selection

Fig. 2

Significant individual cardiovascular diseases and its trajectory progression subsequent to a diagnosis of common psychiatric disease a Hazard ratios (HRs) with 95% confidence intervals (CIs) of significant individual cardiovascular diseases among patients with common psychiatric disorders compared to matched unexposed individuals. ¹Combined ICD-10 code; mapping between the original ICD-10 code and the combined ICD-10 code can be found in Table S2; ²Hazard ratios (with 95% confidence intervals) of different cardiovascular diseases more in patients with common psychiatric disorders compared to matched individuals without psychiatric disorders, derived from Cox regression models stratifying by matching identifiers and adjusted for age, year of birth, TDI, educational level, ethnicity, smoking status, BMI, history of other psychiatric disorders, family history of CVD, and CCI score. b Trajectory progression of cardiovascular disease following a diagnosis of common psychiatric disorders. This figure illustrates following trajectory progression of cardiovascular disease identified in our analysis. The combined cardiovascular diseases are shown within the circle. The color of the nodes represents the hazard ratios of this cardiovascular disease when comparing patients with common psychiatric disorders to matched unexposed individuals. The color of the arrows indicates the odds ratio of the sequential association between the two cardiovascular disease events among patients with common psychiatric disorders