title: Cardiovascular mortality in schizophrenia: defining a critical period for prevention.
abstract: OBJECTIVE
  Better understanding of the temporal development of cardiovascular risk will permit more targeted prevention of premature cardiovascular mortality in schizophrenia.
  
  
  METHODS
  The sample for this analysis was drawn from referrals (between 2006 and '11) to an early psychosis clinic based in a U.S. urban community mental health center. 76 individuals with schizophrenia who were young (mean 22.4 years, SD 4.8), early course (median duration of illness 31 weeks) and with minimal prior antipsychotic exposure (median 2 weeks) were compared to age-, gender-, and race-matched peers drawn from the National Health and Nutrition Survey (2007-'08). Measures of cardiovascular risk at baseline, 6 months, and 1 year are reported.
  
  
  RESULTS
  While indistinguishable from peers at entry, patients suffered pervasive adverse trajectories of cardiovascular risk factors over the subsequent year. 16 of 44 initial non-smokers became nicotine dependent and none of 32 entering smokers quit. 17 patients transitioned to overweight (BMI 25-29.9, n = 3) or obese (BMI>30, n = 14) categories, while only 24 of 38 (63%) sustained normal weight over one year. Similar adverse trends in blood pressure, lipids, and fasting glucose led to an increase in prevalence of metabolic syndrome (1.31% to 5.26%). 10-year cardiovascular risk estimates showed a small and significant increase although remaining in the low risk (<10%) category.
  
  
  CONCLUSIONS
  The early emergence of obesity and smoking in younger schizophrenia samples provides a rational focus for primary prevention of premature cardiovascular mortality. The first year of treatment constitutes the beginning of a critical period for such preventive efforts.
authors: Department of Psychiatry, Yale University, United States. v.h.srihari@gmail.com
authors: Vinod H
authors: VH
authors: Srihari
authors: Vivek H
authors: VH
authors: Phutane
authors: Banu
authors: B
authors: Ozkan
authors: Lydia
authors: L
authors: Chwastiak
authors: Joseph C
authors: JC
authors: Ratliff
authors: Scott W
authors: SW
authors: Woods
authors: Cenk
authors: C
authors: Tek
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology; D008875:Middle Aged; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology* / Q000401:mortality*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents