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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
Open accessAbstract
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 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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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“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]
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“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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Metadata
- 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
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2017-05-12
- Volume
- 16
- Issue
- 2
- Pages
- 163-180
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- 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
- 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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