Mortality and metabolic disorder in schizophrenia and bipolar disorder in Sweden, Denmark and Finland

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1 Mortality and metabolic disorder in schizophrenia and bipolar disorder in Sweden, Denmark and Finland Urban Ösby Karolinska Institutet, Stockholm, Sweden Department of Psychiatry, Tiohundra AB, Norrtälje

2 Standard Mortality Ratios (SMR, Obs/Exp) and excess deaths (Obs-Exp) for Schizophrenia in Stockholm and Bipolar disorder in Sweden Schizophrenia Bipolar disorder Cause of death Obs Exp O/E O-E Obs Exp O/E O-E Cardiovascular Natural causes Suicide Unnatural causes All causes Osby et al 2000, Osby et al 2001

3 Excess deaths by natural and unnatural causes for schizophrenia patients in Stockholm County Men Women Unnatural n=218 38% Natural n=264 47% Unnatural n=296 53% Natural n=352 62% Osby et al 2000

4 Prevalence of diabetes in schizophrenia compared to general population Prevalence of diabetes (%) 30 General population Patients Age group (years) 8.6% diabetes; n=415 De Hert et al 2006

5 CATIE: rates of pharmacological interventions for abnormal blood pressure, lipids and glucose Patients (%) 100 n=1488 n=685 n= n=481 n=300 n=75 n=34 n=471 n=421 Hypertension Diabetes Dyslipidaemia Prevalence Lack of medical intervention Nasrallah et al 2006

6 Diabetes diagnosis, treatment and achievement of treatment goals in (n=881) patients with long-term psychotic disorders. Diagnosis n % Diabetes diagnosis + medical treatment Fasting glucose 7.0 mmol/l* Diabetes diagnosis + no medical treatment Fasting glucose 7.0 mmol/l* No diabetes diagnosis Fasting glucose 7.0 mmol/l* Fasting glucose mmol/l Fasting glucose mmol/l$

7 Hypertension diagnosis, antihypertensive treatment and achievement of treatment goals in (n=927) patients with long-term psychotic disorders. Diagnosis n % Hypertension diagnosis + medical treatment Systolic blood pressure 140 mm Hg or diastolic blood pressure 90* Hypertension diagnosis + no medical treatment Systolic blood pressure 140 mm Hg or diastolic blood pressure 90* No hypertension diagnosis + medical treatment Systolic blood pressure 140 mm Hg or diastolic blood pressure 90* No hypertension diagnosis + no medical treatment Systolic blood pressure 140 mm Hg or diastolic blood pressure 90*

8 Hyperlipidemia diagnosis with LDL>3.0 mmol/l, lipid lowering treatment and achievement of treatment goals in (n=939) patients with long-term psychotic disorders. Diagnosis N % Hyperlipidemia diagnosis + medical treatment LDL>3.0 mmol/l* 7 21 Hyperlipidemia diagnosis + no medical treatment LDL>3.0 mmol/l* No hyperlipidemia diagnosis + no treatment LDL>3.0 mmol/l*

9 Hyperlipidemia diagnosis with total cholesterol >5 mmol/l, lipid lowering treatment and achievement of treatment goals in (n=992) patients with longterm psychotic disorders. Diagnosis N % Hyperlipidemia diagnosis + medical treatment tot. chol >5.0 mmol/l* Hyperlipidemia diagnosis + no medical treatment tot. chol >5.0 mmol/l* No hyperlipidemia diagnosis + no medical treatment tot. chol >5.0 mmol/l*

10 Patients fulfilling the criteria for the metabolic syndrome Risk factors n % Hyperglycemia Elevated triglyceride levels Reduced levels of high density lipoprotein, males Reduced levels of high density lipoprotein, females Elevated waist circumference, males Elevated waist circumference, females Elevated blood pressure Elevated fasting plasma glucose ³5.6 mmol/l, or drug treatment for elevated glucose 2 Elevated triglyceride levels: ³1.7 mmol/l, or drug treatment for dyslipidemia 3 Reduced high-density lipoprotein levels: <1.0 mmol/l in males and 1.3 mmol/l in females, or drug treatment for dyslipidemia 4 Waist circumference 102 cm in males and 88 cm in females. 5 Elevated blood pressure: systolic BP ³130 mm Hg or diastolic BP ³85 mm Hg, or antihypertensive drug treatment

11 Smoking

12 Odds ratios for variables related to increased fasting glucose OR 95% CI Fasting insulin ( 114 pmol/l) Group (control/patient) Waist circumference ( 94 for men, 80 for women) Hypertension Age (>55 yrs) First-degree relative with diabetes Current smoker Gender (female)

13 Odds ratios for variables related to increased waist circumference OR 95% CI Group (control/patient) Gender (female) Hypertension Fasting glucose ( 5.6 mmol/l) First-degree relative with diabetes Age (>55 yrs)

14 Mortality in bipolar disorder in Sweden all causes of death (MRR*, ) RR Age *Mortality rate ratio

15 Mortality in bipolar disorder in Sweden unnatural causes of death (MRR*, ) RR Age *Mortality rate ratio

16 Mortality in bipolar disorder in Sweden Mortality in bipolar disorder in Sweden cardiovascular causes of death (MRR,* ) death (MRR*, ) RR Age *Mortality rate ratio

17 Mortality in bipolar disorder in Sweden cmortality in bipolar disorder in Sweden cerebrovascular causes of death (MRR,* ) s of death (MRR*, ) RR Age *Mortality rate ratio

18 Mortality in bipolar disorder in Sweden Mortality in bipolar disorder in Sweden coronary heart disease (MRR,* ) ase (MRR*, ) RR Age *Mortality rate ratio

19 Mortality in bipolar disorder in Sweden acute myocardial infarction (MRR,* ) olar disorder in Sweden Acute myocardial infarction (MRR*, ) RR Age *Mortality rate ratio

20 Five-year survival of cardiovascular disease in bipolar disorder after discharge from first cardiovascular admission stratified by age at hospital contact. in bipolar disorder in Sweden 1.0 Survival after first CVD diagnosis 0.9 Survivor function estimate Time since hospital admission Bipolar Bipolar Bipolar 80+ Population Population Population 80+

21 Mortality rate ratio from cardiovascular disease to 2006 in Denmark Thomas Munk Laursen, National Centre for Register-based Research

22 Time change in mortality due to cardiovascular diseases, men, Denmark Schizophrenia General population General population Laursen og Nordentoft, Psych Research, 2010

23 Life expectancy and loss of years compared to general population among patients with bipolar disorder and schizophrenia in Denmark, Finland, and Sweden. Life expectanc y Denmark Finland Sweden Loss of years Life expectanc y Men Loss of years Life expectanc y Loss of years General population Bipolar disorder Schizophrenia Life expectanc y Loss of years Life expectanc y Women Loss of years Life expectanc y Loss of years General population Bipolar disorder Schizophrenia Life expectancy and cardiovascular deaths of patients with bipolar disorder or schizophrenia in the Nordic countries. Thomas Munk Laursen, Kristian Wahlbeck, Jonas Hällgren, Jeanette Westman, Urban Ösby, Hassan Alinaghizadeh, Mika Gissler, Merete Nordentoft. In press, Plos One.

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