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

Correll, Christoph U.; Solmi, Marco; Veronese, Nicola; Bortolato, Beatrice; Rosson, Stella; Santonastaso, Paolo; Thapa‐Chhetri, Nita; Fornaro, Michele; Gallicchio, Davide; Collantoni, Enrico; Pigato, Giorgio; Favaro, Angela; Monaco, Francesco; Kohler, Cristiano; Vancampfort, Davy; Ward, Philip B.; Gaughran, Fiona; Carvalho, André F.; Stubbs, Brendon

doi:10.1002/wps.20420

Cited by 1,729Cardiac Health and Mental HealthSchizophrenia research and treatmentMental Health Treatment and Access

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

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Correll, Christoph U., Solmi, Marco, Veronese, Nicola, Bortolato, Beatrice, Rosson, Stella, Santonastaso, Paolo, Thapa‐Chhetri, Nita, Fornaro, Michele +11 more·2017·World Psychiatry

DOI 10.1002/wps.20420PMC PMC5428179

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Abstract

People with severe mental illness (SMI) – schizophrenia, bipolar disorder and major depressive disorder – appear at risk for cardiovascular disease (CVD), but a comprehensive meta‐analysis is lacking. We conducted a large‐scale meta‐analysis assessing the prevalence and incidence of CVD; coronary heart disease; stroke, transient ischemic attack or cerebrovascular disease; congestive heart failure; peripheral vascular disease; and CVD‐related death in SMI patients (N=3,211,768) versus controls (N=113,383,368) (92 studies). The pooled CVD prevalence in SMI patients (mean age 50 years) was 9.9% (95% CI: 7.4‐13.3). Adjusting for a median of seven confounders, patients had significantly higher odds of CVD versus controls in cross‐sectional studies (odds ratio, OR=1.53, 95% CI: 1.27‐1.83; 11 studies), and higher odds of coronary heart disease (OR=1.51, 95% CI: 1.47‐1.55) and cerebrovascular disease (OR=1.42, 95% CI: 1.21‐1.66). People with major depressive disorder were at increased risk for coronary heart disease, while those with schizophrenia were at increased risk for coronary heart disease, cerebrovascular disease and congestive heart failure. Cumulative CVD incidence in SMI patients was 3.6% (95% CI: 2.7‐5.3) during a median follow‐up of 8.4 years (range 1.8‐30.0). Adjusting for a median of six confounders, SMI patients had significantly higher CVD incidence than controls in longitudinal studies (hazard ratio, HR=1.78, 95% CI: 1.60‐1.98; 31 studies). The incidence was also higher for coronary heart disease (HR=1.54, 95% CI: 1.30‐1.82), cerebrovascular disease (HR=1.64, 95% CI: 1.26‐2.14), congestive heart failure (HR=2.10, 95% CI: 1.64‐2.70), and CVD‐related death (HR=1.85, 95% CI: 1.53‐2.24). People with major depressive disorder, bipolar disorder and schizophrenia were all at increased risk of CVD‐related death versus controls. CVD incidence increased with antipsychotic use (p=0.008), higher body mass index (p=0.008) and higher baseline CVD prevalence (p=0.03) in patients vs. controls. Moreover, CVD prevalence (p=0.007), but not CVD incidence (p=0.21), increased in more recently conducted studies. This large‐scale meta‐analysis confirms that SMI patients have significantly increased risk of CVD and CVD‐related mortality, and that elevated body mass index, antipsychotic use, and CVD screening and management require urgent clinical attention.

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Schizophrenia is associated with a 15-20 year life expectancy gap.
“Schizophrenia is associated with one of the highest risks of premature mortality among psychiatric disorders, with a 15–20 year life expectancy gap [1].”
From Trends in Sudden Death Among Schizophrenia Inpatients (2025) · cites this paper as [1]
The introductory passage in our copy (labelled Abstract; page not provided) says severe mental illness, including schizophrenia, is associated with a life expectancy 10–17.5 years shorter than that of the general population. It does not give a schizophrenia-specific 15–20-year gap or establish that schizophrenia has one of the highest premature-mortality risks among psychiatric disorders. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Cardiometabolic risk factors such as cardiovascular disease and obesity are recognised major contributors to increased mortality in schizophrenia.
“While causes are multifactorial, cardiometabolic risk factors such as cardiovascular disease and obesity are recognised major contributors [1,2,10,11].”
From A systematic review of licensed weight-loss medications in treating antipsychotic-induced weight gain and obesity in schizophrenia and psychosis. (2022) · cites this paper as [10]
The Discussion (page unavailable) says cardiovascular disease contributes substantially to premature mortality in severe mental illness, and the longitudinal results report increased cardiovascular-related death in schizophrenia. It also links higher body mass index to cardiovascular morbidity and mortality in the pooled severe-mental-illness population, but does not establish obesity as a major contributor to mortality specifically in schizophrenia. (LLM, conf=0.83)
Experimental — accuracy not yet measured
Rates of diabetes and metabolic syndrome in alcohol or substance use disorders are similar to those seen in severe mental illness.
“Rates of diabetes and metabolic syndrome are similar to those seen in severe mental illness.14,15”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [14]
In alcohol use disorders, the pooled prevalence of type 2 diabetes is 12.4% (95% CI 11.8-13.9).
“Pooled T2DM prevalence = 12.4% (95% CI, 11.8-13.9%)”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [14]

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Authors: Correll, C. U., Solmi, M., Veronese, N., Bortolato, B., Rosson, S., Santonastaso, P., Thapa‐Chhetri, N., Fornaro, M., Gallicchio, D., Collantoni, E., Pigato, G., Favaro, A., Monaco, F., Kohler, C., Vancampfort, D., Ward, P. B., Gaughran, F., Carvalho, A. F., & Stubbs, B.
Affiliations: Albert Einstein College of Medicine (US)
University of Padua (IT)
UConn Health (US)
Columbia University (US)
Department of Clinical Medicine and Translational Psychiatry Research Group Federal University of Ceará Fortaleza Brazil
KU Leuven (BE)
UNSW Sydney (AU)
South London and Maudsley NHS Foundation Trust (GB)
Institute for Clinical Research and Education in Medicine Padua Italy
ORCID: Correll, Christoph U.
Solmi, Marco
Veronese, Nicola
Rosson, Stella
Santonastaso, Paolo
Fornaro, Michele
Gallicchio, Davide
Collantoni, Enrico
Favaro, Angela
Monaco, Francesco
Vancampfort, Davy
Ward, Philip B.
Gaughran, Fiona
Stubbs, Brendon
Venue: World Psychiatry
Publisher: Wiley
Published: 2017-05-12
Volume: 16
Issue: 2
Pages: 163-180
ISSN: 1723-8617 (ISSN-L)
2051-5545
DOI: 10.1002/wps.20420
PMC: PMC5428179
OpenAlex: W2613459819
Semantic Scholar: fb5e3b86e3edce30541c2d8ac7cce8984059dd54
Cited by: 1,729
References: 137
Citations by year: 2026: 176 · 2025: 223 · 2024: 210 · 2023: 196 · 2022: 210 · 2021: 232 · 2020: 185 · 2019: 153 · 2018: 109 · 2017: 32 · 2015: 1
FWCI: 101.38
Type: journal article
Language: en
Update notices: correction (2018-01-19)
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: World Psychiatry (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion)
Research Portal (King's College London) (submittedVersion, other-oa)
Lirias (submittedVersion)
Padua Research Archive (University of Padova) (submittedVersion)
Funders: Stanley Medical Research Institute
King's College Hospital NHS Foundation Trust
National Institute for Health and Care Research
King's College London
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords: cardiovascular disease, severe mental illness, schizophrenia, bipolar disorder, major depressive disorder, coronary artery disease, cerebrovascular disease, stroke, congestive heart failure, peripheral vascular disease, cardiovascular mortality, CVD risk factors, comorbidities, cardiovascular risk stratification, cardiovascular disease prevention, cardiac rehabilitation, cardiovascular education

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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

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