Schizophrenia and the risk of cardiovascular diseases: a meta-analysis of thirteen cohort studies

J Psychiatr Res. 2013 Nov;47(11):1549-56. doi: 10.1016/j.jpsychires.2013.07.011. Epub 2013 Aug 15.


Background: Numerous studies have investigated the relationship between schizophrenia and the incidence of cardiovascular disease (CVD), but their results were not entirely consistent. Our study aimed to elucidate the association between schizophrenia and the risk of CVD by a meta-analysis of cohort studies.

Methods: PubMed, the Cochrane Library, and EMBASE databases were searched to identify relevant studies that met the prespecified inclusion criteria. We also reviewed reference lists from the retrieved articles. Relative risks (RRs) and 95% confidence intervals (CIs) were extracted and pooled using the fixed-effect or random-effects models.

Results: Thirteen studies involving 3,549,950 participants, with outcomes of CVD reported for 422,698, were included in the meta-analysis. The follow-up period ranged from 1.6 to 36.0 years. The meta-analysis found that the pooled RRs for schizophrenia compared with the reference group were 1.53 (95% CI: 1.27-1.86) for the incidence of CVD, 1.20 (95% CI: 0.93-1.53) for coronary heart disease (CHD), 1.71 (95% CI: 1.19-2.46) for stroke, and 1.81 (95% CI: 1.42-2.29) for congestive heart failure (CHF). Sensitivity analysis after the exclusion of a single cohort or using the unadjusted RRs yielded similar results to the primary overall estimations. No evidence of publication bias was observed.

Conclusions: Schizophrenia is associated with increased incidence of CVD, stroke and CHF, and might also increase the risk of CHD. Greater attention should be paid to schizophrenia patients to prevent the occurrence of CVD and to decrease the risk of cardiac morbidity.

Keywords: Cardiovascular disease; Cohort studies; Meta-analysis; Schizophrenia.

Publication types

  • Meta-Analysis

MeSH terms

  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / etiology
  • Cohort Studies
  • Databases, Factual / statistics & numerical data
  • Humans
  • Incidence
  • Schizophrenia / epidemiology*