Relative Risk of Acute Myocardial Infarction in People with Schizophrenia and Bipolar Disorder: A Population-Based Cohort Study.
OBJECTIVE
Despite high mortality associated with serious mental illness, risk of acute myocardial infarction (AMI) remains unclear, especially for patients with bipolar disorder. The main objective was to investigate the relative risk of AMI associated with schizophrenia and bipolar disorders in a national sample.


METHODS
Using nationwide administrative data, an 11-year historic cohort study was assembled, comprised of cases aged 18 and above who had received a diagnosis of schizophrenia or bipolar disorder, compared to a random sample of all other adults excluding those with diagnoses of serious mental illness. Incident AMI as a primary diagnosis was ascertained. Hazard ratios stratified by age and gender were calculated and Cox regression models were used to adjust for other covariates.


RESULTS
A total of 70,225 people with schizophrenia or bipolar disorder and 207,592 people without serious mental illness were compared. Hazard ratios in men adjusted for age, income and urbanization were 1.15 (95% CI 1.01~1.32) for schizophrenia and 1.37 (1.08~1.73)for bipolar disorder, and in women, 1.85 (1.58~2.18) and 1.88(1.47~2.41) respectively. Further adjustment for treated hypertension, diabetes and hyperlipidaemia attenuated the hazard ratio for men with schizophrenia but not the other comparison groups. Hazard ratios were significantly stronger in women than men and were stronger in younger compared to older age groups for both disorders; however, gender modification was only significant in people with schizophrenia, and age modification only significant in people with bipolar disorder.


CONCLUSIONS
In this large national sample, schizophrenia and bipolar disorder were associated with raised risk of AMI in women and in the younger age groups although showed differences in potential confounding and modifying factors.
Mackay Memorial Hospital, Department of Psychiatry, Taipei, Taiwan; Mackay Medical College, Department of Audiology and Speech Language Pathology, Taipei, Taiwan.
Shu-I
SI
Wu
National Taipei University of Nursing and Health Sciences, Department of Health Care Management, Taipei, Taiwan.
Su-Chiu
SC
Chen
Mackay Memorial Hospital, Department of Psychiatry, Taipei, Taiwan; Mackay Junior College of Nursing, Taipei, Taiwan; Mackay Memorial Hospital, Department of Medical Research, Taipei, Taiwan.
Shen-Ing
SI
Liu
Mackay Junior College of Nursing, Taipei, Taiwan; Mackay Memorial Hospital, Department of Medical Research, Taipei, Taiwan.
Fang-Ju
FJ
Sun
Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Jimmy J M
JJ
Juang
Department of Psychiatry, Shuang Ho Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Hsin-Chien
HC
Lee
Far Eastern Memorial Hospital, Department of Pediatrics, Taipei, Taiwan.
Kai-Liang
KL
Kao
King's College London, (Institute of Psychiatry, Psychology & Neuroscience), Health Service and Population Research Department, London, United Kingdom.
Michael E
ME
Dewey
King's College London, (Institute of Psychiatry, Psychology & Neuroscience), Health Service and Population Research Department, London, United Kingdom.
Martin
M
Prince
King's College London, (Institute of Psychiatry, Psychology & Neuroscience), Health Service and Population Research Department, London, United Kingdom.
Robert
R
Stewart
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001714:Bipolar Disorder / Q000150:complications / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012559:Schizophrenia / Q000150:complications / Q000401:mortality*; D012737:Sex Factors