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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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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·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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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
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
Health Sciences › Medicine › Psychiatry and Mental health › 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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