Heart disease treatment and mortality in schizophrenia and bipolar disorder e Changes in the danish population between 1994 and 2006 Thomas Munk Laursen a, * , Merete Nordentoft b a National Center for Register-Based Research, University of Aarhus, Taasingegade 1, DK-8000 Aarhus C, Denmark b Psychiatric Center Copenhagen, Copenhagen University, Faculty of Health Sciences, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark article info Article history: Received 1 October 2009 Received in revised form 26 April 2010 Accepted 28 April 2010 Keywords: Schizophrenia Bipolar disorder Heart disease mortality abstract Persons with schizophrenia and bipolar disorder have much higher heart disease mortality rates than the general population. The objective was to compare the general population with persons with schizo- phrenia, bipolar disorder or other psychiatric disorders in terms of rates of somatic hospitalization and invasive heart disease procedures, and in terms of heart disease mortality during the period 1994 to 2006. Survival analysis was used to analyze heart disease mortality and somatic care trends in a cohort of all persons residing in Denmark. During the study period, heart disease mortality rose significantly among persons with schizophrenia: compared with the general population, the rise in the mortality rate ratio equalled 1.12 (95% confidence interval (CI) 1.08e1.15) every second year. This was not the case for persons with bipolar disorder [1.02 (0.98e1.05), not significant] or other psychiatric disorders [1.00 (0.99e1.01), not significant]. The entire period saw a lower hospitalization rate and fewer invasive cardiac procedures among persons with schizophrenia than among the general population. The higher mortality (with increasing trends) from heart disease in persons with schizophrenia compared to the rest of the cohort members can be explained partly by low rates of invasive cardiac procedures. However, other reasons, such as antipsychotic-induced weight gain, primary prevention, and difficulty following smoking cessation advice could also be part of the explanation. The results call for a greater focus on improvement in somatic care and lifestyle factors for this group of patients. Ó 2010 Elsevier Ltd. All rights reserved. 1. Introduction A review found elevated mortality from natural causes in persons with schizophrenia (standardized mortality ratio (SMR) 1.3) and bipolar affective disorder (SMR ¼ 1.5) (Harris and Barraclough, 1998), which was also found in Nordic register-based studies (Osby et al., 2001, 2000; Joukamaa et al., 2001; Mortensen and Juel, 1993; Laursen et al., 2007). It has been suggested that recent decades have seen a rising tendency in the excess mortality of schizophrenic patients (Saha et al., 2007). Heart disease is considered to be the most common cause of death in Western countries (Laursen, 2006; Hennekens et al., 2005), even if mortality from heart disease in general has declined. This decline has been attributed to improved lifestyle and better medical care (Johnsen et al., 2006; Newcomer and Hennekens, 2007). Patients with schizophrenia and bipolar affective have a higher mortality from cardiac disorders than the general population (Laursen et al., 2007), which has recently been suggested to be attributable, among others, to such patients’ lower frequency of hospitalization for heart disease and lesser exposure to cardiac treatment (Laursen et al., 2009). The aim of the paper was to evaluate the change in heart disease related hospitalizations, invasive heart disease procedures and mortality rates in the Danish population from 1994 to 2006. This was done by comparing patients with schizophrenia, bipolar disorder or other psychiatric disorders with the general population. The main focus was to examine if a divergent development between schizophrenia and the general population was present. 2. Method 2.1. Study population and follow-up All persons residing in Denmark during the period 1994e2006 were identified from The Danish Civil Registration System (Pedersen et al., 2006). Among these, 93.4% have been born in Denmark (2009a). Only persons born in Denmark were selected as cohort members, since psychiatric and somatic illness status before * Corresponding author. Tel.: þ45 89426816; fax: þ45 89426813. E-mail address: tml@ncrr.dk (T.M. Laursen). Contents lists available at ScienceDirect Journal of Psychiatric Research journal homepage: www.elsevier.com/locate/psychires 0022-3956/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.jpsychires.2010.04.027 Journal of Psychiatric Research 45 (2011) 29e35