Mortality trends in cardiovascular disease in schizophrenia in Sweden Urban Ösby MD, PhD, Senior Consultant Psykiatri Nordöst, Stockholm County Council.

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Presentation transcript:

Mortality trends in cardiovascular disease in schizophrenia in Sweden Urban Ösby MD, PhD, Senior Consultant Psykiatri Nordöst, Stockholm County Council Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Declaration of interest: Urban Ösby Grant support: Stockholm County Council, NARSAD, Bristol-Myers Squibb, Janssen-Cilag Advisory Board/Consultant: AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Pfizer Speakers Bureau: AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Pfizer

Risk factors for cardiovascular disase

Lipids Hypertension Age Vascular disease Smoking Obesity Diabetes Diet Family history Sedentary lifestyle Cardiovascular disease: A Multifactorial Condition ENVIRONMENTALENVIRONMENTAL GENETICGENETIC Gender Thrombotic factors

FoamCellsFattyStreakIntermediateLesion Atheroma FibrousPlaqueComplicatedLesion/Rupture Endothelial dysfunction Smooth muscle and collagen From first decade From third decade From fourth decade Growth mainly by lipid accumulation Thrombosis, haematoma Adapted from Stary HC et al. Circulation 1995;92: Cardiovascular Timeline

Causes of death related to age and sex in Sweden Ref: Socialstyrelsen (1997). Hälso- och sjukvårdsstatistisk årsbok Socialstyrelsen, Stockholm. L. Wallentin 2000 Inledn./sid 1

Infectious Cancer Endocrine Mental Nervous system Cardiovascular Cerebrovascular Respiratory Gastrointestinal Urogenital Accidents Suicide Undet violence All causes Males Females SMR (Observed/Expected) for schizophrenia patients in Stockholm County SMR

SMR (Observed/Expected) and Excess deaths (Observed-Expected) for patients with schizophrenia in Stockholm County Ref: Osby U, et al. Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophr Res 2000;45(1-2):21-8.

Excess deaths by natural and unnatural causes for schizophrenia patients in Stockholm County Men Natural % Unnatural % Women Natural % Unnatural % Ref: Osby U, et al. Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophr Res 2000;45(1-2):21-8.

SMR (O/E) and Excess deaths (O–E) for patients with bipolar disorder in Sweden Ref: Osby U, et al. Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry 2001;58(9): Men Women Total Cause of deathObsExpO/EO-EObsExpO/EO-EO/EO-E Cardiovascular Natural causes Suicide Unnatural causes All causes

SMR (O/E) and Excess deaths (O-E) for patients with unipolar disorder in Sweden Ref: Osby U, et al. Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry 2001;58(9): Men Women Total Cause of deathObsExpO/EO-EObsExpO/EO-EO/EO-E Cardiovascular Natural causes Suicide Unnatural causes All causes

Mortality in the population in Stockholm County Standardized by the sex- and age distribution of patients with schizophrenia in Stockholm County Deaths/ All deaths Natural causes of death Cardiovascular deaths Violent deaths Suicide

Mortality trends in Stockholm county , all causes of death Deaths/ year of reference Patients with schizophrenia* General population** * Controlling for age at first diagnosis and years of follow-up **Standardized by the sex and age distribution of the patients Ref: Osby U, et al. Time trends in schizophrenia mortality in Stockholm county, Sweden: cohort study. Bmj 2000;321(7259):483-4.

Deaths/ period of reference Patients with schizophrenia* General population** * Controlling for age at first diagnosis and years of follow-up **Standardized by the sex and age distribution of the patients Mortality trends in Stockholm county to , natural causes of death

Deaths/ period of reference Patients with schizophrenia* General population** * Controlling for age at first diagnosis and years of follow-up **Standardized by the sex and age distribution of the patients Mortality trends in Stockholm County to , cardiovascular causes of death Ref: Osby U, et al. Time trends in schizophrenia mortality in Stockholm county, Sweden: cohort study. Bmj 2000;321(7259):483-4.

Mortality trends in Sweden adjusted for age Men

Mortality trends in Sweden adjusted for age

SMR for schizophrenia in Sweden

Time trends for SMR for all causes of death (p<.0001)

Time trends for SMR for cardiovascular death (p<.0001)

Time trends for SMR for death from coronary heart disease p<.0001)

Time trends for SMR for death from myocardial infarction (p<.0001)

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