Cardiovascular mortality in schizophrenia may be underestimated

By Eleanor McDermid, Senior medwireNews Reporter

Cardiovascular causes account for about a quarter of deaths of patients with schizophrenia and may also contribute to the high rate of unexplained deaths, say researchers.

On examining a series of 683 postmortems, Christopher Semsarian (Centenary Institute, Newtown, New South Wales, Australia) and colleagues found that 11% failed to establish a clear cause of death.

However, they note that 30 of these 72 unexplained deaths were sudden, and affected all ages of patient, with the patients often witnessed alive and well immediately before collapsing.

“[I]t can be hypothesised that a proportion of the ‘unexplained’ cases in this study may be due to an underlying cardiac predisposition causing malignant arrhythmias resulting in unexplained death,” suggest the researchers, adding that this is consistent with studies of sudden death in mentally healthy patients.

The main causes of death were cardiovascular (23%), suicide (20%), and drug toxicity (17%), and the incidences were all significantly higher than those in the Australian population (15%, 2%, <1%, respectively). Drug toxicity included overdoses of medications, as well as illicit drugs, with multiple drugs implicated in nearly half of the cases. Just two patients had major illnesses at the time of death that would have made them vulnerable to drug toxicity.

The cause of death varied according to age, report Semsarian et al in Schizophrenia Research. Patients who were 40 years old or less at the time of death predominantly died of suicide (37%) or drug toxicity (27%), with just 9% dying of cardiovascular causes. By contrast, 29% of patients older than 40 years died of cardiovascular causes, while 14% died of drug toxicity and 13% committed suicide.

Other categories were respiratory causes and “other,” which included infectious, neurologic, and gastrointestinal causes, as well as cancer.

“The findings highlight the importance of careful and regular review of living patients with schizophrenia, including lifestyle and risk factor modification, and judicious use of anti-psychotic therapies, with the ultimate goal to reduce morbidity and mortality in schizophrenia,” concludes the team.

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