Osborn, David Philip John; (2004) Cardiovascular risk factors in people with schizophrenia and similar illnesses: A cross-sectional study in primary care. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Chapter 1: The literature search explores increased physical mortality and morbidity in schizophrenia, with a specific focus on cardiovascular disease (CVD) and risk factors. Recent evidence reveals an escalating problem. Chapter 2: Methods A cross-sectional study in 7 inner city general practices, comparing people with and without schizophrenia. Potential participants were invited to attend a cardiovascular risk assessment, including cholesterol levels, blood pressure, smoking and diabetic status. A 10 year cardiovascular risk score was generated. Diet and exercise were assessed using validated instruments as well as cardiovascular risk factor knowledge and health care. Results were analysed using stepwise multivariate methods. Chapters 3 and 4: 75/182 (41.2%) people with schizophrenia (or similar) accepted CVD screening, compared with 150/313 (47.9%) comparison patients. The difference was only statistically significant when frequency of GP attendance was considered. The participating sample was representative. Chapter 5 and 6: On statistical analysis, more participants with schizophrenia showed significantly raised 10 year CVD risk scores than the comparison group. This is due to raised total cholesterol, low HDL cholesterol, smoking and diabetes. Older age was an effect modifier of the increased cardiovascular risk. Socio-economic variables could not explain these differences on multivariate analysis. Chapter 7 and 8: Low fibre diet, lack of leisure time exercise and less health knowledge were more common in schizophrenia. GPs provided similar physical care to both groups. Socio-economic variables do not explain the findings. Chapter 9: Conclusions. CVD risk screening is acceptable and imperative in people with schizophrenia. Smoking, exercise, poor diet, diabetes and cholesterol all interact to increase CVD risk (and therefore mortality) in people with schizophrenia. Careful multivariate analysis shows that socioeconomic factors do not explain the majority of the findings. The effects were not simply attributable to antipsychotic medication. Results are compared with existing literature and clinical research implications are outlined.

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