Cardiovascular risk in institutionalised schizophrenic patients

Citation: European Neuropsychopharmacology
The Journal of the European College of Neuropsychopharmacology
Volume 21 (2011), Supplement 3, Page S458(Tuesday, 06 September 2011)

P. de Usabel Guzmán1, M.J. Mota Rodríguez1, R. Ramos Ríos2, M. Arrojo Romero2, J. Brenlla González1

1Hospital Profesor Gil Casares, Psiquiatría, Santiago de Compostela, Spain
2Hospital Psiquiátrico de Conxo, Psiquiatría, Santiago de Compostela, Spain

Justification: The cardiovascular risk is the likelihood of cardiovascular disease in a given period, usually 10 years. Cardiovascular disease (heart and cerebrovascular disease) is the leading cause of death in patients with schizophrenia, where the rate of mortality is higher than the general population [1,2]. The impact of physical disease on the survival of patients with schizophrenia, specifically cardiovascular disease, has not been studied in depth, and the same applies to systematic literature in institutionalized schizophrenic patients.
Objectives: The aim of this work is to study the cardiovascular risk in a sample of institutionalized schizophrenics. It further analyses the relative risk in relation to cardiovascular risk variables: chronological age coded, presence of hypertension, diabetes mellitus, hypercholesterolemia and low HDL cholesterol.
Material and Methods: We selected all patients admitted to the Psychiatric Hospital of Conxo who fulfilled the criteria for schizophrenia according to DSM-IV-TR. REGICOR was the equation used to calculate cardiovascular risk (calibration of the original Framingham equation modified for the Spanish population). The subjects ranged in age from 35 to 75. The sample consisted of 129 patients. We coded age ranges: <45 years, between 45 and 54 years, between 55 and 64 years and over 64 (following criteria Marrugat et al for coronary risk estimation in Spain [3]). For the statistical study we used the SPSS 15.
Results: The average parametric variables: TAS (125.31 mmHg), DBP (74.64 mmHg), glucose averages 104.47 mg/dl, total cholesterol (198.47 mg/dl), LDL cholesterol (130.42 mg/dl), and HDL (39.82 mg/dl) are within normal limits. HDL cholesterol levels (protective) were higher in women than in men with statistically significant differences (p = 0.000).
In the sample of patients studied, 58% are smokers, and there are marked differences between both genders. 72% of the male patients smoke, while 31% of the female in the sample share this habit (p = 0.00). Smoking decreases with chronological age (p = 0.02).
16% of the sample consists of diabetics, from which 17% were hypertensive, with no gender differences.
The average value of cardiovascular risk obtained in our sample is 6.26%.
The 43% of patients have a low risk of suffering a cardiovascular event, 40% a slight risk, 13% moderate risk and 3% high risk with no statistically significant differences between sexes.
Moderate and high cardiovascular risk increases with chronological age, especially in those over 55 years, who have a cardiovascular risk of 31%.
There is a positive association between cardiovascular risk and smoking, hypertension, hyperlipidemia, low HDL cholesterol and sex (male), although the two variables with the greatest impact on cardiovascular risk are age and DM with an odds ratio of 26.95 and 10 respectively.
Conclusions: The physical health of patients with schizophrenia can and should be improved from the Mental Health professionals with a greater degree of intervention on modifiable risk factors, which still needs to be developed, and with the implementation of specific psychoeducational programs that incorporate physical health issues which schizophrenic patients are most commonly affected by.

References:
1. Druss B.G., Bradford W.D., Rosenheck R.A., Radford M.J., Krumholz H.M. (2001). Quality of medical care and excess mortality in older patients with mental disorders. Arch Gen Psychiatry, 58(6): 565–572.
2. Bernardo M., Cañas F., Banegas J.R., Casademont J., Riesgo Y., Varela C. (2009). Prevalence and awareness of cardiovascular risk factors in patients with schizophrenia: a cross-sectional study in a low cardiovascular disease risk geographical area. RICAVA Study Group. Eur Psychiatry, 24(7): 431–441.
3. Marrugat J., Solanas P., D'Agostinod R., Sullivand L., Ordovase J., Cordón F., et al. (2003). Estimación del riesgo coronario en España mediante la ecuación de Framingham calibrada. Rev Esp Cardiol, 56(3): 253–261.