title: Cardiovascular morbidity, mortality and pharmacotherapy in patients with schizophrenia.
abstract: BACKGROUND
  Patients with schizophrenia have excess cardiovascular morbidity and mortality. Previous studies suggest that this may be partly due to inadequate somatic treatment and care, such as non-optimal use of lipid-lowering and antihypertensive pharmacotherapy, but longitudinal studies on such aetiological pathways are scarce.
  
  
  METHODS
  We investigated the use of lipid-lowering and antihypertensive pharmacotherapy, and the risk of hospitalization for and death from coronary heart disease and stroke among patients with schizophrenia in a birth cohort of 12 939 subjects (Helsinki Birth Cohort Study). This cohort was followed for over 30 adult years by using national databases on cardio- and cerebrovascular hospitalizations and mortality and on reimbursement entitlements and use of drugs for treatment of hypertension, dyslipidaemia, coronary heart disease and diabetes.
  
  
  RESULTS
  Individuals with schizophrenia had a higher risk of hospitalization for coronary heart disease [hazard ratio (HR) 1.65, 95% confidence interval (CI) 1.03-2.57], and mortality from this disease was markedly higher (HR 2.92, 95% CI 1.70-5.00), particularly among women (p=0.001 for women, p=0.008 for men). Women with schizophrenia had also marginally increased stroke mortality (p=0.06). However, patients with schizophrenia used less lipid-lowering (odds ratio 0.47, 95% CI 0.27-0.80) and antihypertensive drug treatment (HR 0.37, 95% CI 0.22-0.61).
  
  
  CONCLUSIONS
  In this longitudinal study, coronary heart disease morbidity was increased and coronary heart disease mortality markedly increased in patients, especially in women with schizophrenia. These patients nevertheless received less antihypertensive and lipid-lowering treatment.
authors.affiliation: Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Lahti
authors.affiliation: Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Tiihonen
authors.affiliation: Hiram Consulting, Ackworth, West Yorkshire, UK.
authors.forename: H
authors.initials: H
authors.lastname: Wildgust
authors.affiliation: Priority Hospital North London, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Beary
authors.affiliation: Lyme Brook Centre, Newcastle-under-Lyme, Staffordshire, UK.
authors.forename: R
authors.initials: R
authors.lastname: Hodgson
authors.affiliation: Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: E
authors.initials: E
authors.lastname: Kajantie
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
authors.forename: C
authors.initials: C
authors.lastname: Osmond
authors.affiliation: Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
authors.forename: K
authors.initials: K
authors.lastname: Räikkönen
authors.affiliation: Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Eriksson
mesh_terms: D000368:Aged; D015897:Comorbidity; D003327:Coronary Disease / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D012042:Registries / Q000706:statistics & numerical data*; D012559:Schizophrenia / Q000453:epidemiology*; D012737:Sex Factors; D020521:Stroke