دانلود رایگان مقاله انگلیسی عوامل خطر برای مرگ زودرس ناشی از گردش خون در بیماران مبتلا به اسکیزوفرنی - الزویر 2018

ABSTRACT

Patients with schizophrenia have higher mortality and shortened life expectancy than the general population, and cardiovascular disease (CVD) accounts for up to 50% cases of early mortality in schizophrenia. We determined risk factors, particularly pathophysiological changes, for early circulatory mortality in schizophrenia. In this multi-institutional, nested, case–control study, we enrolled consecutive inpatients with schizophrenia admitted to three psychiatric hospitals in the northern Taiwan. Seventy-nine patients who died of CVD before 65 years of age were identified as cases through record linkage, and 158 controls were randomly selected in a 2:1 ratio through risk-set density sampling, after matching for age ( ± 2 years), sex, and index admission ( ± 3 years). Data were obtained through medical record reviews. At the time of death, the mean age of the patients was 47.5 years (standard deviation = 10.3). Conditional logistic regression revealed that the duration of antipsychotic treatment was significantly associated with a lower risk of early circulatory mortality, and leukocyte counts at index hospitalization were significantly associated with a higher risk. Systemic inflammation may be a risk factor for early circulatory mortality in schizophrenia, but antipsychotic treatment, in particular typical antipsychotic treatment, could be a protective factor.

Discussion

In this multi-institutional, nested, case–control study, we investigated risk factors for early circulatory mortality in patients with schizophrenia. A previous study measuring the 25-year mortality of schizophrenia reported there was an apparent increase in circulatory mortality relative to the general population, and cigarette smoking, one of traditional CVD risk factors, may account for majority of the excess natural mortality in the cohort (Brown et al., 2010). However, the cohort study failed to identify other non-traditional risk factors. The present study yielded two major findings; compared with the living patients with schizophrenia, the deceased ones had 1) a higher count of leukocytes and 2) a shorter duration of all antipsychotic treatments, after adjustment for clinical illness variables, cardiovascular variables, and laboratory data at the index admission. First, the elevated leukocyte counts in the patients with schizophrenia were more associated with circulatory mortality than with traditional cardiovascular risk factors, including smoking, BMI, hyperlipidemia, and ECG measurements. Elevated leukocyte counts, as an indicator of systemic inflammation, was reported to predict coronary heart disease progression in patients with preexisting vascular diseases (Danesh et al., 1998). Moreover, the leukocyte count may serve as an independent predictor of adverse events following intervention for myocardial infarction (Kojima et al., 2004). Therefore, systemic inflammation may be strongly associated with early circulatory mortality in patients with schizophrenia as repeatedly observed in patients with bipolar disorder (Tsai et al., 2005). Our results are consistent with a previous study reporting that an unbalanced immune response may be associated with the inflammatory process of the central nervous system, in which dopaminergic, serotonergic, noradrenergic, and glutamatergic neurotransmission is influenced by immune alternations in schizophrenia (Muller et al., 2015).