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Psychiatric disorders and subsequent risk of cardiovascular disease: a longitudinal matched cohort study across three countries
Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China; Institute for Advanced Study, Tongji University, Shanghai, China; Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Institute of Biological Psychiatry, Mental Health Services Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia.
Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Medical Big Data Center, Sichuan University, Chengdu, China.
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2023 (English)In: eClinicalMedicine, E-ISSN 2589-5370, Vol. 61, article id 102063Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Several psychiatric disorders have been associated with increased risk of cardiovascular disease (CVD), however, the role of familial factors and the main disease trajectories remain unknown.

METHODS: In this longitudinal cohort study, we identified a cohort of 900,240 patients newly diagnosed with psychiatric disorders during January 1, 1987 and December 31, 2016, their 1,002,888 unaffected full siblings, and 1:10 age- and sex-matched reference population from nationwide medical records in Sweden, who had no prior diagnosis of CVD at enrolment. We used flexible parametric models to determine the time-varying association between first-onset psychiatric disorders and incident CVD and CVD death, comparing rates of CVD among patients with psychiatric disorders to the rates of unaffected siblings and matched reference population. We also used disease trajectory analysis to identify main disease trajectories linking psychiatric disorders to CVD. Identified associations and disease trajectories of the Swedish cohort were validated in a similar cohort from nationwide medical records in Denmark (N = 875,634 patients, same criteria during January 1, 1969 and December 31, 2016) and in Estonian cohorts from the Estonian Biobank (N = 30,656 patients, same criteria during January 1, 2006 and December 31, 2020), respectively.

FINDINGS: During up to 30 years of follow-up of the Swedish cohort, the crude incidence rate of CVD was 9.7, 7.4 and 7.0 per 1000 person-years among patients with psychiatric disorders, their unaffected siblings, and the matched reference population. Compared with their siblings, patients with psychiatric disorders experienced higher rates of CVD during the first year after diagnosis (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.79-1.98) and thereafter (1.37; 95% CI, 1.34-1.39). Similar rate increases were noted when comparing with the matched reference population. These results were replicated in the Danish cohort. We identified several disease trajectories linking psychiatric disorders to CVD in the Swedish cohort, with or without mediating medical conditions, including a direct link between psychiatric disorders and hypertensive disorder, ischemic heart disease, venous thromboembolism, angina pectoris, and stroke. These trajectories were validated in the Estonian Biobank cohort.

INTERPRETATION: Independent of familial factors, patients with psychiatric disorders are at an elevated risk of subsequent CVD, particularly during first year after diagnosis. Increased surveillance and treatment of CVDs and CVD risk factors should be considered as an integral part of clinical management, in order to reduce risk of CVD among patients with psychiatric disorders.

Place, publisher, year, edition, pages
Elsevier, 2023. Vol. 61, article id 102063
Keywords [en]
Cardiovascular disease, Disease trajectory, Family design, Psychiatric disorders, Sibling
National Category
Psychiatry Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-107069DOI: 10.1016/j.eclinm.2023.102063ISI: 001054892100001PubMedID: 37425374Scopus ID: 2-s2.0-85173492654OAI: oai:DiVA.org:oru-107069DiVA, id: diva2:1781752
Funder
EU, Horizon 2020, 847776Swedish Research Council, D0886501The Research Council of Norway, 223273, 296030, 300309, 324252European Regional Development Fund (ERDF), 2014-2020.4.01.15-0012
Note

Funding agencies:

European Research Council Consolidator grant 726413

Icelandic Research fund

US NIMH R01 MH123724

Outstanding Clinical Discipline Project of Shanghai Pudong PWYgy2021-02

Fundamental Research Funds for the Central Universities

South-East Regional Health Authority 2017-112 2022-073 

Stiftelsen Kristian Gerhard Jebsen SKGJ-MED-008 SKGJ-MED-021 

EEA-RO-NO-2018-0535

Available from: 2023-07-11 Created: 2023-07-11 Last updated: 2023-12-08Bibliographically approved

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