Cardiovascular disease and mortality in people with schizophrenia or antipsychotic treatment: A cohort study in primary care.

People with schizophrenia (SZ) or under treatment with antipsychotic drugs (TAD) are considered to be at high risk of cardiovascular (CV) morbidity and mortality, but the reasons are not fully understood. In addition, no longitudinal studies in the setting of primary care in Spain have been performed. We aimed at analysing the incidence of cardiovascular disease (CVD) and CV mortality in the population with SZ and in the population without SZ but under TAD (NS-TAD). METHODS: Retrospective cohort study in primary care in Spain, based on data from computerized medical records and mortality recorded in the National Statistics Institute. Three groups were generated: SZ, NS-TAD and control group, with a 4-year follow-up period (2008 to 2011). RESULTS: In an adjusted model, SZ was established as an independent risk factor for CV mortality although not with non-fatal CVD incidence. The NS-TAD group was an independent risk factor for mortality of any cause and CVD, but not CV mortality. CONCLUSIONS: Differences between SZ and NS-TAD support that SZ has an increased risk of CVD independently of TAD. Further studies to evaluate the origin and management are needed. The detection of CVD and the consequent secondary CV prevention in these high-risk populations should be prioritized. Herein, a greater interaction between primary care and mental health services is eagerly needed.

Prevalence and incidence of chronic complications and mortality in a cohort of type 2 diabetic patients in Spain.

AIMS: To evaluate the prevalence, incidence of micro- and macrovascular complications, final events, and mortality in type 2 diabetic patients, followed over a period of 10 years in Spain. METHODS: Prospective, population-based cohort study. 317 type 2 diabetic patients treated at a Primary Care Centre, followed for 10 years. Variables were described by means of ratios, mean values and standard deviation. The chi(2) test was used to compare ratios and the Student's t test to compare mean values. RESULTS: Mean age in women (61%) was 61.2 years; men 66.7 years. With regard to the prevalence of complications, the following was observed: an increase in nephropathy (12%), in retinopathy (6.2%) and in neuropathy (2.1%), a decrease in ischemic cardiomyopathy (-6.2%), an increase in peripheral vascular disease (5.6%). Cerebrovascular event and diabetic foot remaining unchanged. The highest incidence rates (1000 subjects/year) were: nephropathy 43, neuropathy 39 and ischemic cardiomyopathy 32. The prevalence of cardiovascular risk factors increased over the follow-up; being high blood pressure the most noticeable (30%). Overall mortality was 28/1000 subjects/year, being cardiovascular disease the main cause (31.2%). CONCLUSIONS: Our study determines the prevalence and incidence of chronic complications and risk factors in Spain.