Decreased cardiovascular death in schizophrenia patients treated with antipsychotics: A Korean national cohort study

Schizophr Res. 2021 Feb;228:417-424. doi: 10.1016/j.schres.2021.01.006. Epub 2021 Feb 5.


Background: Patients with schizophrenia have a reduced life expectancy, but the association between antipsychotic usage and cause of death is uncertain.

Methods: The authors observed associations of antipsychotic usage with the mortality rate and cause of death in a population-based cohort of the Korean National Health Insurance Service database from 2003 to 2017. A total of 86,923 patients with schizophrenia were categorized by the total duration of antipsychotic prescription after schizophrenia diagnosis into treated (n = 77,139) and untreated (n = 9784) groups. The main outcome was all-cause mortality; causes of death included cardiovascular disease, pulmonary disease, diabetes, cancer, accident, suicide and homicide.

Results: The numbers of all-cause deaths and deaths from individual causes were significantly lower in the antipsychotic-treated group than in the untreated group (all cases, p < 10-4). When adjusted for covariates (age, sex, income, body mass index, alcohol consumption, hypertension, cancer and cerebral stroke), mortality rates due to ischemic heart disease (hazard ratio, HR, 0.38 [95% CI, 0.18-0.77]) and stroke (HR, 0.39 [95% CI, 0.19-0.80]) were significantly lower in the antipsychotic-treated group. Among 4 atypical antipsychotics (olanzapine, risperidone, aripiprazole and quetiapine), only aripiprazole was associated with a decreased mortality risk relative to olanzapine (HR, 0.55 [95% CI, 0.32-0.96]).

Conclusions: Schizophrenia patients constantly prescribed antipsychotics had significantly lower rates of death from certain cardiovascular illnesses than untreated patients. Aripiprazole-treated schizophrenia was associated with a decreased risk of death compared with olanzapine-treated disease.

Keywords: Antipsychotics; Cardiovascular diseases; Mortality; National cohort; Schizophrenia.

MeSH terms

  • Antipsychotic Agents* / adverse effects
  • Benzodiazepines / therapeutic use
  • Cohort Studies
  • Humans
  • Quetiapine Fumarate / therapeutic use
  • Republic of Korea / epidemiology
  • Schizophrenia* / drug therapy
  • Schizophrenia* / epidemiology


  • Antipsychotic Agents
  • Benzodiazepines
  • Quetiapine Fumarate