Heart risk for people with schizophrenia

Australians with schizophrenia die 25 years earlier than others due to poor heart health.

Australians with schizophrenia die 25 years earlier than the general population, due mostly to cardiovascular deaths and poor heart health, University of Sydney researchers reveal in the Medical Journal of Australia.

The physical health of people with schizophrenia needs serious and urgent national attention, according to the report’s authors, who say a lack of coordinated care between hospitals, community mental health services, GPs and other primary healthcare professionals is responsible for the gap in life expectancy.

“This is a preventable tragedy,” said the report’s senior author, psychiatrist, Professor Tim Lambert of the University of Sydney Collaborative Centre for Cardiometabolic Health in Psychosis (ccCHiP).

“People with schizophrenia and psychosis die early in life mainly from heart attacks, heart disease and strokes due to untreated hypertension and high cholesterol, and high rates of obesity and smoking.

“There is no mystery about how to manage these diseases and risk factors. They should have their physical health checked annually by GPs and primary healthcare professionals and, where possible, reviewed in specialised multidisciplinary settings such as ccCHiP to formulate longer term interventions and preventative follow-up.”

The report also says psychotropic agents, used in the treatment of schizophrenia and psychosis, can increase weight and promote dyslipidemia (abnormal blood fats) that elevate the risk of poor heart health.

The new research finds Clozapine (an antipsychotic drug used to treat the most severe forms of schizophrenia) is linked to a higher the risk of myocarditis and cardiomyopathy (heart conditions that can cause sudden cardiac death), though with appropriate medical care is among the safest of the antipsychotics with respect to premature death.

Patients starting clozapine therapy should be screened for myocarditis have ongoing monitoring for cardiomyopathy with echocardiography, say the authors, as part of the more general management of cardio-metabolic risk in this highly vulnerable population.

Fast facts

• One in three illness-related deaths among people with schizophrenia is due to cardiovascular disease.
• Compared to the general population, people with schizophrenia have up to a threefold increased risk of both coronary artery disease and sudden cardiac death.
• Up to 88% of people with schizophrenia have untreated dyslipidaemia.
• Up to 62% of people with schizophrenia have high blood pressure.

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