Middle-aged smokers with schizophrenia are significantly more likely to die from cardiac disease

Smoking man

We know from epidemiological studies that people with schizophrenia are 2-3 times more likely to smoke than the rest of the population.  We also know that schizophrenia is associated with a higher risk of coronary heart disease.

This retrospective cohort study carried out by researchers from the University of Maryland set out to explore the impact of smoking on mortality in people with schizophrenia or schizoaffective disorder. The research team used the inpatient admission records of 1,213 adults (aged 19-69) who had been admitted for the first time and had recorded information on smoking on their records. People treated only with first generation antipsychotics or no antipsychotic at the time of admission were excluded.

More than half (54.7%) of the participants in the study were smokers. Smokers were defined as anyone who smoked cigarettes on admission or who had a history of dependence on cigarettes. Researchers reviewed clinical records to collect data on DSM-IV diagnoses, smoking status, substance use and comorbid conditions. Analyses were adjusted for age, gender, race and antipsychotic treatment.

Here’s what the researchers found:

  • 43% of deaths in smokers were cardiac related, compared with 19% of non-smokers
  • In people and aged 35–54:
    • Cardiac-related mortality was 12 times higher among smokers compared with non-smokers (HR 12.4, 95% CI 3.0 to 51.4, p=0.0005).
    • People who smoked heavily (≥1 pack a day) were almost three times more likely to die compared with those who did not smoke (HR 2.7, 95% CI 1.71 to 4.16)
The authors concluded:
Smoking increases the risk of all cause mortality and also cardiac-related death in people aged 35–54 with schizophrenia. This risk is increased with increasing amount smoked.

Kelly DL, McMahon RP, Wehring HJ, Liu F, Mackowick KM, Boggs DL, Warren KR, Feldman S, Shim JC, Love RC, Dixon L. Cigarette smoking and mortality risk in people with schizophrenia. Schizophr Bull. 2011 Jul;37(4):832-8. Epub 2009 Dec 17. [PubMed abstract]


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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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