Why the study?
Cardiovascular mortality is the leading cause of shortened life expectancy in severe mental illness, but efforts to predict cardiovascular outcomes in these patients have been lacking.
Does severe mental illness increase mortality risk and coronary artery calcification severity compared to the general population?
Does severe mental illness increase mortality risk and coronary artery calcification severity compared to the general population?
Patients with severe mental illness have increased mortality independent of coronary artery calcification severity, with no significant difference in baseline CAC scores compared to the general population.
SMI mortality risk persists independent of CAC; hypothesis-generating and should not yet change CAC-based risk assessment.
Background Cardiovascular mortality is the leading contributor to the shortened life expectancy in patients with severe mental illness (SMI), but efforts to predict cardiovascular outcomes in these patients have been lacking. In this study, we aimed to determine the severity of coronary artery calcification (CAC), and its effect on mortality rates in patients with SMI, compared with the general population. Methods All individuals with a registered cardiac computed tomography for calcium scoring in the Western Denmark Heart Registry, from January 1, 2008 to December 31, 2016, were included. We identified patients diagnosed with SMI ( International Classification of Diseases, Tenth Revision: F20, F30, F31), whereas the remaining individuals were used as a comparison group. Results Among 48 757 individuals, including 564 patients with SMI (1.2%), we found no difference in CAC score between patients with SMI and the comparison group. SMI patients with CAC >100 had an increased mortality rate (hazard ratio, 3.16; 95% CI, 1.41-7.06), as well as SMI patients with CAC <100 (hazard ratio, 3.95; 95% CI, 2.36-6.62), compared with the comparison group with CAC <100 as reference, adjusted for age, sex, and calendar period. Conclusions Patients with SMI have increased cardiovascular risks, but show no difference in CAC score, compared with the comparison group. Mortality rates were increased in patients with SMI, independent of CAC severity; however, the relatively large number of noncardiovascular causes of death in this sample might indicate other contributing factors to death than coronary artery disease in this sample of SMI patients.
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Kugathasan et al. (2019) studied this question.
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