Increased cardiac mortality in patients with schizophrenia may be reduced by effectively administered cardioprotective treatment after cardiac events, according to research published in JAMA Psychiatry. Patients with schizophrenia have heightened cardiovascular morbidity and mortality, and secondary preventive treatment shows promise in reducing adverse effects.
Researchers examined 105,018 patients with myocardial infarction (MI) in a nationwide cohort study to assess the association of exposure to secondary cardiovascular treatment and mortality in patients with schizophrenia vs the general population. Of the total number of patients with MI, 684 patients diagnosed with schizophrenia were enrolled. Researchers obtained data based on the prescription of cardioprotective meditation and time exposed to cardioprotective medication. Investigators used Cox proportional hazards regression to calculate hazard ratios. The primary outcome of the study was time to all-cause mortality using time of medication exposure as a time-dependent covariate. A secondary outcome was time to all-cause mortality by comparing exposure to monotherapy, dual therapy, and triple therapy in patients with or without schizophrenia.
Patients with schizophrenia who did not receive cardioprotective treatment had the highest mortality rates (hazard ratio 8.78; 95% CI, 4.37-17.64) compared with the general population who were treated. Patients with schizophrenia who were treated had an increased hazard ratio of 1.97. The results showed that patients with schizophrenia who received any combination of triple therapy treatments had mortality rates similar to those of the general population.
The study was limited by a lack of information on the severity of patients’ MI and in-hospital medication as well as the lack of data on treatment exposure based on whether patients redeemed prescriptions.
“Given the increased cardiovascular risk among patients with schizophrenia, we believe that the current findings support the use of intensive cardioprotective treatments in patients with schizophrenia,” the researchers noted. In addition, they advocate that cardioprotective medication after MI should be carefully managed and increased after cardiac events in patients with schizophrenia.
Kugathasan P, Horsdal HT, Aagaard J, Jensen SE, Laursen TM, Nielsen RE. Association of secondary preventive cardiovascular treatment after myocardial infarction with mortality among patients with schizophrenia [published online October 24, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2018.2742