Incidence of ischaemic heart disease and stroke among people with psychiatric disorders: retrospective cohort study

BackgroundPsychiatric disorders are associated with increased risk of ischaemic heart disease (IHD) and stroke, but it is not known whether the associations or the role of sociodemographic factors have changed over time.AimsTo investigate the association between psychiatric disorders and IHD and stroke, by time period and sociodemographic factors.MethodWe used Scottish population-based records from 1991 to 2015 to create retrospective cohorts with a hospital record for psychiatric disorders of interest (schizophrenia, bipolar disorder or depression) or no record of hospital admission for mental illness. We estimated incidence and relative risks of IHD and stroke in people with versus without psychiatric disorders by calendar year, age, gender and area-based deprivation level.ResultsIn all cohorts, incidence of IHD (645 393 events) and stroke (276 073 events) decreased over time, but relative risks decreased for depression only. In 2015, at the mean age at event onset, relative risks were 2- to 2.5-fold higher in people with versus without a psychiatric disorder. Age at incidence of outcome differed by cohort, gender and socioeconomic status. Relative but not absolute risks were generally higher in women than men. Increasing deprivation conveys a greater absolute risk of IHD for people with bipolar disorder or depression.ConclusionsDespite declines in absolute rates of IHD and stroke, relative risks remain high in those with versus without psychiatric disorders. Cardiovascular disease monitoring and prevention approaches may need to be tailored by psychiatric disorder and cardiovascular outcome, and be targeted, for example, by age and deprivation level.

Download Full-text

Risk and coaggregation of major psychiatric disorders among first-degree relatives of patients with bipolar disorder: a nationwide population-based study

Psychological Medicine ◽

10.1017/s003329171800332x ◽

2018 ◽

Vol 49 (14) ◽

pp. 2397-2404 ◽

Cited By ~ 7

Author(s):

Mu-Hong Chen ◽

Ju-Wei Hsu ◽

Kei-Lin Huang ◽

Tung-Ping Su ◽

Cheng-Ta Li ◽

...

Keyword(s):

Bipolar Disorder ◽

Psychiatric Disorders ◽

Population Based ◽

Autism Spectrum ◽

The Public ◽

First Degree Relatives ◽

Relative Risks ◽

Dependent Relationship ◽

Increased Risk ◽

Bipolar Patients

AbstractBackgroundBipolar disorder is a highly heritable mental illness that transmits intergeneratively. Previous studies supported that first-degree relatives (FDRs), such as parents, offspring, and siblings, of patients with bipolar disorder, had a higher risk of bipolar disorder. However, whether FDRs of bipolar patients have an increased risk of schizophrenia, major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD) remains unclear.MethodsAmong the entire population in Taiwan, 87 639 patients with bipolar disorder and 188 290 FDRs of patients with bipolar disorder were identified in our study. The relative risks (RRs) of major psychiatric disorders were assessed among FDRs of patients with bipolar disorder.ResultsFDRs of patients with bipolar disorder were more likely to have a higher risk of major psychiatric disorders, including bipolar disorder (RR 6.12, 95% confidence interval (CI) 5.95–6.30), MDD (RR 2.89, 95% CI 2.82–2.96), schizophrenia (RR 2.64, 95% CI 2.55–2.73), ADHD (RR 2.21, 95% CI 2.13–2.30), and ASD (RR 2.10, 95% CI 1.92–2.29), than the total population did. These increased risks for major psychiatric disorders were consistent across different familial kinships, such as parents, offspring, siblings, and twins. A dose-dependent relationship was also found between risk of each major psychiatric disorder and numbers of bipolar patients.ConclusionsOur study was the first study to support the familial coaggregation of bipolar disorder with other major psychiatric disorders, including schizophrenia, MDD, ADHD, and ASD, in a Taiwanese (non-Caucasian) population. Given the elevated risks of major psychiatric disorders, the public health government should pay more attention to the mental health of FDRs of patients with bipolar disorder.

Download Full-text

Incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes

Cardiovascular Diabetology ◽

10.1186/s12933-021-01313-7 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Amy Groenewegen ◽

Victor W. Zwartkruis ◽

Betül Cekic ◽

Rudolf. A. de Boer ◽

Michiel Rienstra ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Ischaemic Heart Disease ◽

Incidence Rate ◽

Diabetes Status ◽

Increased Risk ◽

Patients With Diabetes ◽

Rate Ratios ◽

Age And Sex

Abstract Background Diabetes has strongly been linked to atrial fibrillation, ischaemic heart disease and heart failure. The epidemiology of these cardiovascular diseases is changing, however, due to changes in prevalence of obesity-related conditions and preventive measures. Recent population studies on incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes are needed. Methods A dynamic longitudinal cohort study was performed using primary care databases of the Julius General Practitioners’ Network. Diabetes status was determined at baseline (1 January 2014 or upon entering the cohort) and participants were followed-up for atrial fibrillation, ischaemic heart disease and heart failure until 1 February 2019. Age and sex-specific incidence and incidence rate ratios were calculated. Results Mean follow-up was 4.2 years, 12,168 patients were included in the diabetes group, and 130,143 individuals in the background group. Incidence rate ratios, adjusted for age and sex, were 1.17 (95% confidence interval 1.06–1.30) for atrial fibrillation, 1.66 (1.55–1.83) for ischaemic heart disease, and 2.36 (2.10–2.64) for heart failure. Overall, incidence rate ratios were highest in the younger age categories, converging thereafter. Conclusion There is a clear association between diabetes and incidence of the major chronic progressive heart diseases, notably with heart failure with a more than twice increased risk.

Download Full-text

Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline

The British Journal of Psychiatry ◽

10.1192/bjp.bp.105.013045 ◽

2006 ◽

Vol 189 (2) ◽

pp. 124-131 ◽

Cited By ~ 186

Author(s):

R. M. Post ◽

L. L. Altshuler ◽

G. S. Leverich ◽

M. A. Frye ◽

W A. Nolen ◽

...

Keyword(s):

Bipolar Disorder ◽

Bipolar Depression ◽

Antidepressant Drugs ◽

Patient Treatment ◽

Adjunctive Treatment ◽

Prior History ◽

Rapid Cycling ◽

Acute Response ◽

Relative Risks ◽

Increased Risk

BackgroundFew studies have examined the relative risks of switching into hypomania or mania associated with second-generation antidepressant drugs in bipolar depression.AimsTo examine the relative acute effects of bupropion, sertraline and venlafaxine as adjuncts to mood stabilisers.MethodIn a 10-week trial, participants receiving out-patient treatment for bipolar disorder (stratified for rapid cycling) were randomly treated with a flexible dose of one of the antidepressants, or their respective matching placebos, as adjuncts to mood stabilisers.ResultsA total of 174 adults with bipolar disorder I, II or not otherwise specified, currently in the depressed phase, were included. All three antidepressants were associated with a similar range of acute response (49–53%) and remission (34–41%). There was a significantly increased risk of switches into hypomania or mania in participants treated with venlafaxine compared with bupropion or sertraline.ConclusionsMore caution appears indicated in the use of venlafaxine rather than bupropion or sertraline in the adjunctive treatment of bipolar depression, especially if there is a prior history of rapid cycling.

Download Full-text

Electronic Record Linkage cohort study of evidence-based management and outcomes in patients with ischaemic heart disease and atrial fibrillation

10.23889/suthesis.58169 ◽

2021 ◽

Author(s):

◽

Edward Daniel Harris

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Ischaemic Heart Disease ◽

Evidence Based Medicine ◽

Lipid Lowering ◽

Evidence Based ◽

Lipid Lowering Therapy ◽

Lipid Levels ◽

Increased Risk ◽

Based Medicine

BACKGROUND Implementation of evidence-based medicine is often suboptimal. The objectives of this thesis are to explore the delivery of evidence-based medicine and outcomes in patients with ischaemic heart disease (IHD) and atrial fibrillation (AF). METHODS Retrospective observational cohort studies were conducted using linked anonymised data from the secure anonymised information linkage (SAIL) databank. Patients included (i) those undergoing percutaneous coronary intervention, (ii) patients prescribed vitamin K antagonist (VKA) for AF, and (iii) patients with AF who had undergone successful PCI. RESULTS Amongst patients directed to take clopidogrel for one-year post-PCI, discontinuation was far lower (~6%) than in previous studies where the treatment duration was not known. Despite this, early discontinuation and/or bleeding was associated with an increased risk of adverse events. In a national cohort of PCI patients, we observed a low rate of achievement of international guideline target lipid levels (<25%) and low prescribing of intensive lipid lowering therapy amongst those not at target. Females and patients who had undergone elective PCI were least likely to have their lipid levels documented and be at target. In patients prescribed VKA for AF guideline defined poor anticoagulation control was common and associated with significantly higher bleeding event rates, independent of common comorbidities that are recognised as risk factors for stroke and bleeding. In patients with AF who had undergone PCI outcomes were poor: approximately 1 in 5 had either a stroke, acute coronary syndrome (ACS) or died in the year follow-up. Bleeding events were also common and associated with a five, three and four-fold increased risk of stroke, ACS, and death. CONCLUSION This thesis has characterised the nature of multiple therapeutic gaps and associated adverse outcomes with common clinical conditions. Thus, identifying opportunities to improve outcomes in individual patients and at population level.

Download Full-text

Trauma-related mortality of patients with severe psychiatric disorders: population-based study from the French national hospital database

The British Journal of Psychiatry ◽

10.1192/bjp.2019.139 ◽

2019 ◽

Vol 217 (4) ◽

pp. 568-574

Author(s):

Guillaume Fond ◽

Vanessa Pauly ◽

Thierry Bege ◽

Veronica Orleans ◽

David Braunstein ◽

...

Keyword(s):

Bipolar Disorder ◽

Psychiatric Disorders ◽

Psychiatric Diagnosis ◽

Hospital Admissions ◽

Social Deprivation ◽

Sociodemographic Characteristics ◽

Survival Prognosis ◽

Trauma Severity ◽

Increased Risk ◽

Related Mortality

BackgroundMost research on mortality in people with severe psychiatric disorders has focused on natural causes of death. Little is known about trauma-related mortality, although bipolar disorder and schizophrenia have been associated with increased risk of self-administered injury and road accidents.AimsTo determine if 30-day in-patient mortality from traumatic injury was increased in people with bipolar disorder and schizophrenia compared with those without psychiatric disorders.MethodA French national 2016 database of 144 058 hospital admissions for trauma was explored. Patients with bipolar disorder and schizophrenia were selected and matched with mentally healthy controls in a 1:3 ratio according to age, gender, social deprivation and region of residence. We collected the following data: sociodemographic characteristics, comorbidities, trauma severity characteristics and trauma circumstances. Study outcome was 30-day in-patient mortality.ResultsThe study included 1059 people with bipolar disorder, 1575 people with schizophrenia and their respective controls (n = 3177 and n = 4725). The 30-day mortality was 5.7% in bipolar disorder, 5.1% in schizophrenia and 3.3 and 3.8% in the controls, respectively. Only bipolar disorder was associated with increased mortality in univariate analyses. This association remained significant after adjustment for sociodemographic characteristics and comorbidities but not after adjustment for trauma severity. Self-administered injuries were associated with increased mortality independent of the presence of a psychiatric diagnosis.ConclusionsPatients with bipolar disorder are at higher risk of 30-day mortality, probably through increased trauma severity. A self-administered injury is predictive of a poor survival prognosis regardless of psychiatric diagnosis.

Download Full-text

Prognostic impact over time of ischaemic heart disease vs. non‐ischaemic heart disease in heart failure

ESC Heart Failure ◽

10.1002/ehf2.12568 ◽

2020 ◽

Vol 7 (1) ◽

pp. 265-274

Author(s):

Jonas Silverdal ◽

Helen Sjöland ◽

Entela Bollano ◽

Aldina Pivodic ◽

Ulf Dahlström ◽

...

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Ischaemic Heart Disease ◽

Prognostic Impact ◽

Over Time

Download Full-text

INCREASED RISK OF ISCHAEMIC HEART DISEASE IN SHIFT WORKERS

The Lancet ◽

10.1016/s0140-6736(86)91619-3 ◽

1986 ◽

Vol 328 (8498) ◽

pp. 89-92 ◽

Cited By ~ 224

Author(s):

Anders Knutsson ◽

BjornG. Jonsson ◽

Torbjorn Akerstedt ◽

Kristina Orth-Gomer

Keyword(s):

Heart Disease ◽

Ischaemic Heart Disease ◽

Shift Workers ◽

Increased Risk

Download Full-text

Epidemiology, morbidity and mortality in Behçet’s disease: a cohort study using The Health Improvement Network (THIN)

Rheumatology ◽

10.1093/rheumatology/keaa010 ◽

2020 ◽

Vol 59 (10) ◽

pp. 2785-2795 ◽

Cited By ~ 1

Author(s):

Tom Thomas ◽

Joht Singh Chandan ◽

Anuradhaa Subramanian ◽

Krishna Gokhale ◽

George Gkoutos ◽

...

Keyword(s):

Pulmonary Embolism ◽

Cohort Study ◽

Heart Disease ◽

General Population ◽

Venous Thrombosis ◽

Ischaemic Heart Disease ◽

Thromboembolic Disease ◽

Age And Gender ◽

Increased Risk ◽

And Gender

Abstract Objectives The epidemiology of Behçet’s disease (BD) has not been well characterized in the UK. Evidence on the risk of cardiovascular disease, thromboembolic disease and mortality in patients with BD compared with the general population is scarce. Methods We used a large UK primary care database to investigate the epidemiology of BD. A retrospective matched cohort study was used to assess the following outcomes: risk of cardiovascular, thromboembolic disease and mortality. Controls were selected at a 1:4 ratio (age and gender matched). Cox proportional hazard models were used to derive adjusted hazard ratios (aHR). Results The prevalence of BD was 14.61 (95% CI 13.35–15.88) per 100 000 population in 2017. A total of 1281 patients with BD were compared with 5124 age- and gender-matched controls. There was significantly increased risk of ischaemic heart disease [aHR 3.09 (1.28–7.44)], venous thrombosis [aHR 4.80 (2.42–9.54)] and mortality [aHR 1.40 (1.07–1.84)] in patients with BD compared with corresponding controls. Patients with BD were at higher risk of pulmonary embolism compared with corresponding controls at baseline [adjusted odds ratio 4.64 (2.66–8.09), P < 0.0001]. The majority of patients with pulmonary embolism and a diagnosis of BD had pulmonary embolism preceding the diagnosis of BD, not after (87.5%; n = 28/32). Conclusion BD has a higher prevalence than previously thought. Physicians should be aware of the increased risk of developing ischaemic heart disease, stroke/transient ischaemic attack and deep venous thrombosis in patients with BD at an earlier age compared with the general population. Risk of embolism in patients with BD might vary across the disease course.

Download Full-text

62 Predictors of Tardive Dyskinesia in Psychiatric Patients Taking Concomitant Antipsychotics

CNS Spectrums ◽

10.1017/s1092852919000488 ◽

2019 ◽

Vol 24 (1) ◽

pp. 207-208 ◽

Cited By ~ 1

Author(s):

Oscar Patterson-Lomba ◽

Rajeev Ayyagari ◽

Benjamin Carroll

Keyword(s):

Quality Of Life ◽

New York ◽

Bipolar Disorder ◽

Depressive Disorder ◽

Prediction Model ◽

Psychiatric Disorders ◽

Index Date ◽

Atypical Antipsychotics ◽

Increased Risk

AbstractBackgroundTardive dyskinesia (TD) is typically caused by exposure to antipsychotics, is often irreversible, and can be debilitating. TD symptoms can increase the social stigma of patients with comorbid psychiatric disorders, negatively impact quality of life, and potentially increase medical morbidity and mortality. An increased risk of developing TD has been associated with factors such as older age, female sex, underlying mental illness, and long-term use and higher doses of antipsychotics. The association of TD with the use of typical versus atypical antipsychotics has also been evaluated, with mixed results. To date, predictive models assessing the joint effect of clinical characteristics on TD risk have not been developed and validated in the US population.Study ObjectiveTo develop a prediction model to identify patient and treatment characteristics associated with the occurrence of TD among patients with psychiatric disorders taking antipsychotic medications, using a retrospective database analysis.MethodsAdult patients with schizophrenia, major depressive disorder, or bipolar disorder who were taking oral antipsychotics, and who had 6months of data prior to the index date were identified from Medicaid claims from six US states. The index date was defined as the date of the first claim for an antipsychotic drug after a claim for the underlying disorder but before TD diagnosis. A multivariate Cox prediction model was developed using a cross-validated version of the least absolute shrinkage and selection operator (LASSO) regression method to improve prediction accuracy and interpretability of the model. The predictive performance was assessed in a separate validation set via model discrimination (concordance) and calibration.ResultsA total of 189,415 patients were identified: 66,723 with bipolar disorder, 68,573 with depressive disorder, and 54,119 with schizophrenia. The selected prediction model had a clinically meaningful concordance of 70% and was well calibrated (P=0.46 for Hosmer–Leme show goodness-of-fit test). Patient’s age at index date (hazard ratio [HR]: 1.03), diagnosis of schizophrenia (HR: 1.73), dosage of antipsychotic at index date (up to 100mg/day chlorpromazine equivalent; HR: 1.40), and presence of bipolar and related disorders (HR: 1.16) were significantly associated with an increased risk of TD diagnosis. Use of atypical antipsychotics at index date was associated with a modest reduction in the risk of TD (HR=0.94).ConclusionsThis study identified a group of factors associated with the development of TD among patients with psychiatric disorders treated with antipsychotics. This may allow physicians to better monitor their patients receiving antipsychotics, allowing for the prompt identification and treatment of TD to help maintain quality of life.Presented at: American Psychiatric Association Annual Meeting; May 5–9, 2018, New York, New York, USAFunding Acknowledgements: This study was supported by Teva Pharmaceuticals, Petach Tikva, Israel.

Download Full-text

HIGH RISK OF NEW PSYCHIATRIC DISORDERS AND SUICIDAL BEHAVIOR IN DEMENTIA

Innovation in Aging ◽

10.1093/geroni/igz038.1150 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S314-S314

Author(s):

Amy Lai ◽

Yixia Li ◽

Amy Byers

Keyword(s):

Psychiatric Disorders ◽

Suicidal Behavior ◽

Sociodemographic Factors ◽

Department Of Veterans Affairs ◽

Dementia Diagnosis ◽

Dementia Patients ◽

Hazard Ratios ◽

Increased Risk ◽

Cox Proportional Hazard Models ◽

Services Use

Abstract Occurrence of new mental health (MH) disorders in patients with dementia is neglected, with next to nothing known. We examined association between dementia diagnosis and risk of new psychiatric disorders and suicide, and MH services use. We merged four national databases from US Department of Veterans Affairs. Sample included 2,529,181 patients (≥50 years) in fiscal years (FY) 2012-2013 with no MH disorders. Dementia, psychiatric disorders (mood, anxiety, substance), suicidal behavior (ideation, plan, attempt, death by suicide) were identified by ICD-9/10 codes and national suicide databases. Hazard ratios (HR) were estimated using Cox proportional hazard models, with time-to-event defined as age at first diagnosis of MH disorder during FY 2014-2016. Analyses adjusted for medical/sociodemographic factors. Compared to those without dementia, dementia patients showed roughly 2-fold increased risk of new mood (HR: 2.19, 95% Wald CI: 2.15-2.24, p<.001) or anxiety (HR: 1.56, 95% CI: 1.50-1.63, p<.001) disorders. Recent dementia diagnosis was associated with highest risk of these disorders than prior or no diagnosis; for example, patients with recent diagnosis showed 72% greater risk of anxiety disorders (HR: 1.72, 95% CI: 1.63-1.81, p<.001). Although patients with prior dementia diagnosis had lower risk of suicidal behavior, risk increased with recent dementia diagnosis. However, dementia patients with new MH disorders showed little MH services use (< 20%). Patients with dementia have increased risk of new MH disorders, especially recent dementia diagnosis. Furthermore, MH services are underutilized, highlighting critical need for integration of such services in caring for dementia patients.

Download Full-text