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Cardioprotective medication after heart attack may reduce mortality in schizophrenia

Secondary prevention cardiovascular treatment prescribed after myocardial infarction was linked to reduced mortality rates among patients with schizophrenia, study findings showed.

“Taking recommended cardioprotective medication after myocardial infarction (MI) reduces hospital admissions, health care costs, and all-cause mortality in patients without psychiatric conditions,” Pirathiv Kugathasan, MSc, department of psychiatry, Aalborg University Hospital in Denmark, and colleagues wrote. “Studies on the prescription rate of cardioprotective medication in patients with [severe mental illness] have been limited, and no studies have examined the association of prophylactic cardiac treatment exposure with mortality rates after MI in patients with schizophrenia compared with the rates in the general population.”

Researchers compared the connection between secondary cardiovascular treatment use and all-cause mortality after MI among patients with schizophrenia vs. the general population in a nationwide cohort study using data from Danish health care registries. Cardioprotective medication included antithrombotics, beta-blockers, vitamin K antagonists, angiotensin-converting enzyme inhibitors and statins. The primary outcome was time to all-cause mortality using time exposed to cardioprotective medication as a time-dependent covariate.

Overall, 684 patients with schizophrenia and 104,334 general population patients experienced MI. Total follow-up was 796,435 person-years and 28,059 deaths occurred over the study period. The results showed that patients with schizophrenia who did not receive cardioprotective treatment experienced the highest mortality rate (HR = 8.78; 95% CI, 4.37-17.64) compared with the general population treated, with treated patients showing an increased HR of 1.97 (95% CI, 1.25-3.1).

However, when analyzing the relationships between different cardiac therapy strategies and mortality rates, Kugathasan and colleagues found that patients with schizophrenia who received any combination of triple therapy experienced mortality rates like those observed in the general population (HR = 1.05; 95% CI, 0.43-2.52).

“In our study, treatment with cardiac triple therapy was associated with reduced excess mortality rates among patients with schizophrenia, which could suggest a necessity of implementing and monitoring multiple secondary preventive cardiac treatments in patients with schizophrenia,” the researchers wrote in JAMA Psychiatry. “Given the increased cardiovascular risk among patients with schizophrenia, we believe that the current findings support the use of intensive cardioprotective treatments inpatients with schizophrenia.”

Although people diagnosed with schizophrenia in Denmark continue to see substantial gaps in quality and lifespan, medical advances help improve longevity among the general population, Benjamin G. Druss, MD, MPH, of Emory University Rollins School of Public Health, wrote in a related comment.

“While medical advances have helped improve longevity in the general public, people with schizophrenia continue to lag behind,” he wrote. “We must be vigilant in tracking the health and mortality outcomes of these individuals and developing policies and programs to ensure that they are able to share in these gains.” – by Savannah Demko

Disclosure : Kugathasan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Druss reports no relevant financial disclosures.