Recent-Onset CV Disease Raises Risk for a Psychiatric Diagnosis

12/07/2022

The study covered in this summary was published on MedRxiv.org as a preprint and has not yet been peer reviewed.

Key Takeaways

Patients diagnosed with cardiovascular disease (CVD) are at increased risk for a psychiatric diagnosis, independent of family characteristic, comorbidities, and medical history.
Development of a psychiatric disorder in the year after a CVD diagnosis is associated with an increased risk for CVD mortality.

Why This Matters

The large-scale prospective, controlled study suggests CVD is a predictor a psychiatric diagnosis. The risk was highest in the year after a CVD diagnosis, pointing to a time window for heightened clinical surveillance.
The impact of a psychiatric diagnosis on CVD mortality further highlights the need for increased surveillance for psychiatric disorders in patients with newly diagnosed CVD.

Study Design

A total of 869,056 patients with newly diagnosed CVD from 1987 to 2016 and who were free of psychiatric disorders were identified in a Swedish national registry covering inpatient and specialized outpatient care. Patients younger than 5 years were excluded to help prevent inclusion of patients with congenital heart disease.
All living full siblings of patients in the newly diagnosed CVD cohort, and specifically those who were free of CVD and psychiatric diagnoses, were identified in the country’s Multi-Generation Register. About 58% of the CVD cohort had such siblings.
Ten age- and sex-matched people from the general population who were free of CVD and psychiatric disorders were randomly selected for each patient with a new CVD diagnosis
Flexible parametric models and Cox regression were used to estimate the strength of the association between CVD and risk for subsequent psychiatric disorders.
Rates of incident psychiatric diagnoses were compared among CVD patients and their full siblings and population control subjects.
Psychiatric diagnoses included nonaffective and affective psychotic disorders, alcohol or drug abuse, mood disorders without psychotic symptoms, anxiety and stress-related disorders, eating disorders, and personality disorders.

Key Results

Median age at CVD diagnosis was 60 years, and 59.2% of those patients were male.
The rates of a new psychiatric diagnosis over 30 years of follow-up were 7.1, 4.6, and 4.0 per 1000 person-years for patients with CVD, their siblings, and matched population-based control subjects, respectively.
The patients with CVD showed an increased adjusted risk for a new psychiatric diagnosis in the year after their CVD diagnosis, compared with their siblings, with a hazard ratio (HR) of 2.74 (95% CI, 2.62 – 2.87). The corresponding HR for the period after the first year was 1.45 (95% CI, 1.42 – 1.48).
The risk during both time windows was elevated across the range of observed psychiatric diagnoses and types of CVD.
In general, the risk for a new psychiatric diagnosis was similar for the non-CVD siblings and the population-based control subjects.
Patients with CVD who developed a comorbid psychiatric disorder in the year after the CVD diagnosis showed an increased risk for CVD-related death, compared with such patients who didn’t develop a psychiatric comorbidity, with an adjusted HR of 1.55 (95% CI, 1.44 – 1.67).

Limitations

The identification of patients in the Swedish Patient Register through outpatient records could have led to an underestimation of the actual number of patients with CVD and psychiatric disorders.
Patients seen in a primary care setting were not included, which could have led to an underestimation of the proportion of patients with psychiatric diagnoses at baseline.
The study could not control for lifestyle factors, such as smoking, diet, and exercise levels, so there might have been residual confounding in the case–sibling comparisons.

Disclosures

Funding was provided by the EU Horizon 2020 Research and Innovation Action Grant, Grant of Excellence, Icelandic Research Fund, ERC Consolidator Grant, Swedish Research Council, and US NIMH R01 MH123724.
The authors declared that there are no conflicts of interest.

This is a summary of a preprint research study, Cardiovascular disease and subsequent risk of psychiatric disorders: a nationwide sibling-controlled study, written by Qing Shen, from the Karolinska Institutet in Stockholm, and colleagues on MedRxiv.org provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on MedRxiv.org.

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