Friday, October 26, 2018

Cardioprotective Treatments After Heart Attack Increase Lifespan of Patients With Schizophrenia

The increased risk of mortality in patients with schizophrenia can be reduced with cardioprotective medication, such as antiplatelets, β-blockers, and statins, after a heart attack, suggests a study published in JAMA Psychiatry.

Previous studies have found that patients with schizophrenia die 10 to 15 years younger and have worse outcomes from coronary artery disease than those in the general population.

“Our study suggests that patients with schizophrenia who are treated with cardioprotective treatment after MI [myocardial infarction] have a lower mortality risk compared with patients who are not treated, similar to those treated in the general population,” wrote Pirathiv Kugathasan, M.D., of Aalborg University in Denmark and colleagues. “Cardioprotective medication after myocardial infarction should be carefully managed to improve prognosis.”

The researchers studied all adults aged 30 and older who were treated in Denmark public hospitals with first-time myocardial infarction (MI) during a 20-year period, involving 105,018 individuals, including 684 patients with a prior diagnosis of schizophrenia. The researchers followed patients up to 20 years and collected data on prescriptions received and defined five cardioprotective therapeutic drug groups: antiplatelets, vitamin K antagonists, β-blockers, angiotensin-converting enzyme inhibitors, and statins. The researchers noted use of monotherapy (treatment with one these medication groups), dual therapy (use of two), and triple therapy (use of three or more) as well as the time to all-cause mortality during the follow-up.

Compared with patients in the general population, patients with schizophrenia were less likely to receive prescriptions for cardioprotective medications after MI. Such patients were nearly nine times more likely to die compared with the general population treated; moreover, even those who received treatment were still nearly twice as likely to die as those treated in the general population.

The triple therapy provided the greatest benefit for patients, however, and patients with schizophrenia who received any combination of triple therapy had mortality rates similar to those observed of the general population who received the same treatment.

“Cardiovascular medications are a mainstay for ensuring health and preventing recurrent cardiovascular events after myocardial infarction,” Benjamin G. Druss, M.D., M.P.H., of Emory University wrote in an accompanying editorial. “The findings of the study by Kugathasan et al suggest that these medications can also play a critical role in reducing mortality among individuals with schizophrenia.”

For related information, see the Psychiatric News article “Patients With Serious Mental Illness Need Better Primary Care Integration, Health Advocacy.”

(Image: iStock/Eraxion)


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