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  • Shen, QingClinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China; Institute for Advanced Study, Tongji University, Shanghai, China; Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (author)

Psychiatric disorders and subsequent risk of cardiovascular disease : a longitudinal matched cohort study across three countries

  • Article/chapterEnglish2023

Publisher, publication year, extent ...

  • Elsevier,2023
  • printrdacarrier

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  • LIBRIS-ID:oai:DiVA.org:oru-107069
  • https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-107069URI
  • https://doi.org/10.1016/j.eclinm.2023.102063DOI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:153597863URI

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  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

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  • Funding agencies:European Research Council Consolidator grant 726413Icelandic Research fundUS NIMH R01 MH123724Outstanding Clinical Discipline Project of Shanghai Pudong PWYgy2021-02Fundamental Research Funds for the Central UniversitiesSouth-East Regional Health Authority 2017-112 2022-073 Stiftelsen Kristian Gerhard Jebsen SKGJ-MED-008 SKGJ-MED-021 EEA-RO-NO-2018-0535
  • BACKGROUND: Several psychiatric disorders have been associated with increased risk of cardiovascular disease (CVD), however, the role of familial factors and the main disease trajectories remain unknown.METHODS: In this longitudinal cohort study, we identified a cohort of 900,240 patients newly diagnosed with psychiatric disorders during January 1, 1987 and December 31, 2016, their 1,002,888 unaffected full siblings, and 1:10 age- and sex-matched reference population from nationwide medical records in Sweden, who had no prior diagnosis of CVD at enrolment. We used flexible parametric models to determine the time-varying association between first-onset psychiatric disorders and incident CVD and CVD death, comparing rates of CVD among patients with psychiatric disorders to the rates of unaffected siblings and matched reference population. We also used disease trajectory analysis to identify main disease trajectories linking psychiatric disorders to CVD. Identified associations and disease trajectories of the Swedish cohort were validated in a similar cohort from nationwide medical records in Denmark (N = 875,634 patients, same criteria during January 1, 1969 and December 31, 2016) and in Estonian cohorts from the Estonian Biobank (N = 30,656 patients, same criteria during January 1, 2006 and December 31, 2020), respectively.FINDINGS: During up to 30 years of follow-up of the Swedish cohort, the crude incidence rate of CVD was 9.7, 7.4 and 7.0 per 1000 person-years among patients with psychiatric disorders, their unaffected siblings, and the matched reference population. Compared with their siblings, patients with psychiatric disorders experienced higher rates of CVD during the first year after diagnosis (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.79-1.98) and thereafter (1.37; 95% CI, 1.34-1.39). Similar rate increases were noted when comparing with the matched reference population. These results were replicated in the Danish cohort. We identified several disease trajectories linking psychiatric disorders to CVD in the Swedish cohort, with or without mediating medical conditions, including a direct link between psychiatric disorders and hypertensive disorder, ischemic heart disease, venous thromboembolism, angina pectoris, and stroke. These trajectories were validated in the Estonian Biobank cohort.INTERPRETATION: Independent of familial factors, patients with psychiatric disorders are at an elevated risk of subsequent CVD, particularly during first year after diagnosis. Increased surveillance and treatment of CVDs and CVD risk factors should be considered as an integral part of clinical management, in order to reduce risk of CVD among patients with psychiatric disorders.

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  • Mikkelsen, Dorte HeleniusInstitute of Biological Psychiatry, Mental Health Services Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark (author)
  • Luitva, Laura BirgitEstonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia (author)
  • Song, HuanUnit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Medical Big Data Center, Sichuan University, Chengdu, China (author)
  • Kasela, SilvaEstonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia (author)
  • Aspelund, ThorCentre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland (author)
  • Bergstedt, JacobUnit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (author)
  • Lu, YiKarolinska Institutet (author)
  • Sullivan, Patrick F.Karolinska Institutet (author)
  • Ye, WeiminDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (author)
  • Fall, Katja,1971-Örebro universitet,Institutionen för medicinska vetenskaper,Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden(Swepub:oru)kafl (author)
  • Tornvall, PerKarolinska Institutet (author)
  • Pawitan, YudiDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (author)
  • Andreassen, Ole A.NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway (author)
  • Buil, AlfonsoiPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Mental Health Center Sct. Hans, Mental Health Services, Capital Region Denmark, Roskilde, Denmark (author)
  • Milani, LiliEstonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia (author)
  • Fang, FangUnit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (author)
  • Valdimarsdóttir, UnnurUnit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States (author)
  • Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China; Institute for Advanced Study, Tongji University, Shanghai, China; Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, SwedenInstitute of Biological Psychiatry, Mental Health Services Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark (creator_code:org_t)

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