Quick Take: Association of Secondary Preventive Cardiovascular Treatment After Myocardial Infarction With Mortality Among Patients With Schizophrenia
Patients with schizophrenia have a shortened life expectancy of 15-20 years compared with the general population, with excess cardiac mortality contributing to this difference. Interestingly, no studies have evaluated the impact of cardioprotective medications after myocardial infarction (MI) in this patient population. In this nationwide cohort study, investigators examined 105,018 patients with MI, including 684 patients with schizophrenia, in order to examine whether exposure to cardioprotective medication reduces all-cause mortality after MI among patients with schizophrenia compared with the general population. Investigators found that patients with schizophrenia had a higher prevalence of diabetes (32.5% vs. 23.8%, p<0.001), COPD (45.9% vs. 37.5%, p<0.001), and substance abuse (25.0% vs. 4.6%, p<0.001), and were less likely to be treated with antiplatelets, vitamin K antagonists, beta-blockers, ACEIs, and statins than the general population (p<0.001 for all comparisons). In terms of mortality, 44.9% of patients with schizophrenia included in this study died compared to 26.6% of the general population. Patients with schizophrenia and no cardioprotective treatment had the highest mortality rate in comparison to the general population (HR 8.78, 95% CI 4.37 to 17.65), while patients with schizophrenia and cardioprotective treatment also had a higher mortality rate than the general population (HR 1.97, 95% CI 1.25 to 3.10). Taken together, results from this study support improving exposure to cardioprotective medications in patients with schizophrenia. This study was limited in that treatment exposure was measured by whether patients obtained prescriptions, with no information on medication adherence. The data analyzed from this study also lacked information on important lifestyle factors and confounders, including smoking and diet.
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