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World Psychiatry. 2017 Jun;16(2):163-180. doi: 10.1002/wps.20420.

Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls.

Author information

Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA.
Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA.
Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
Institute for Clinical Research and Education in Medicine, Padua, Italy.
Department of Neurosciences, University of Padua, Padua, Italy.
Mental Health Department, Local Health Unit 17, Padua, Italy.
Mental Health Department, Local Health Unit 10, Portogruaro, Italy.
University of Connecticut Health Center, Farmington, CT, USA.
New York Psychiatric Institute, Columbia University, New York, NY, USA.
Department of Clinical Medicine and Translational Psychiatry Research Group, Federal University of Ceará, Fortaleza, Brazil.
KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
KU Leuven University Psychiatric Center, Leuven-Kortenberg, Belgium.
School of Psychiatry, University of New South Wales, Sydney, Australia.
South London and Maudsley, NHS Foundation Trust, London, UK.
Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

Erratum in


People with severe mental illness (SMI) - schizophrenia, bipolar disorder and major depressive disorder - appear at risk for cardiovascular disease (CVD), but a comprehensive meta-analysis is lacking. We conducted a large-scale meta-analysis assessing the prevalence and incidence of CVD; coronary heart disease; stroke, transient ischemic attack or cerebrovascular disease; congestive heart failure; peripheral vascular disease; and CVD-related death in SMI patients (N=3,211,768) versus controls (N=113,383,368) (92 studies). The pooled CVD prevalence in SMI patients (mean age 50 years) was 9.9% (95% CI: 7.4-13.3). Adjusting for a median of seven confounders, patients had significantly higher odds of CVD versus controls in cross-sectional studies (odds ratio, OR=1.53, 95% CI: 1.27-1.83; 11 studies), and higher odds of coronary heart disease (OR=1.51, 95% CI: 1.47-1.55) and cerebrovascular disease (OR=1.42, 95% CI: 1.21-1.66). People with major depressive disorder were at increased risk for coronary heart disease, while those with schizophrenia were at increased risk for coronary heart disease, cerebrovascular disease and congestive heart failure. Cumulative CVD incidence in SMI patients was 3.6% (95% CI: 2.7-5.3) during a median follow-up of 8.4 years (range 1.8-30.0). Adjusting for a median of six confounders, SMI patients had significantly higher CVD incidence than controls in longitudinal studies (hazard ratio, HR=1.78, 95% CI: 1.60-1.98; 31 studies). The incidence was also higher for coronary heart disease (HR=1.54, 95% CI: 1.30-1.82), cerebrovascular disease (HR=1.64, 95% CI: 1.26-2.14), congestive heart failure (HR=2.10, 95% CI: 1.64-2.70), and CVD-related death (HR=1.85, 95% CI: 1.53-2.24). People with major depressive disorder, bipolar disorder and schizophrenia were all at increased risk of CVD-related death versus controls. CVD incidence increased with antipsychotic use (p=0.008), higher body mass index (p=0.008) and higher baseline CVD prevalence (p=0.03) in patients vs.


Moreover, CVD prevalence (p=0.007), but not CVD incidence (p=0.21), increased in more recently conducted studies. This large-scale meta-analysis confirms that SMI patients have significantly increased risk of CVD and CVD-related mortality, and that elevated body mass index, antipsychotic use, and CVD screening and management require urgent clinical attention.


Cardiovascular disease; bipolar disorder; cerebrovascular disease; congestive heart failure; coronary heart disease; major depression; premature mortality; schizophrenia; severe mental illness

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