Coronary artery calcium in patients with schizophrenia

Trine Trab, Rubina Attar, Svend Eggert Jensen, Simon Grøntved, Jens Brøndum Frøkjær, Christoffer Polcwiartek, René Ernst Nielsen, Trine Trab, Rubina Attar, Svend Eggert Jensen, Simon Grøntved, Jens Brøndum Frøkjær, Christoffer Polcwiartek, René Ernst Nielsen

Abstract

Background: Coronary heart disease (CHD) is a major cause of increased mortality rates in patients with schizophrenia. Moreover, coronary artery calcium (CAC) score is associated with CHD. We hypothesized that patients with schizophrenia have more CAC than the general population and aimed to investigate the CAC score in patients with schizophrenia compared to norms based on the general population. Additionally, this study investigated if age, sex, diabetes, dyslipidemia and smoking were associated with the CAC score.

Methods: In a cross-sectional study, 163 patients with schizophrenia underwent cardiac computed tomography, and the CAC score was measured and compared to norms by classifying the CAC scores in relation to the age- and gender matched norm 50th, 75th and 90th percentiles. Logistic and linear regression were carried out to investigate explanatory variables for the presence and extent of CAC, respectively.

Results: A total of 127 (77.9%) patients had a CAC score below or equal to the matched 50th, 20 (12.3%) above the 75th and nine (5.5%) above the 90th percentile. Male sex (P < 0.05), age (P < 0.001) and smoking (P < 0.05) were associated with the presence of CAC while age (P < 0.001) and diabetes (P < 0.01) were associated with the extent of CAC.

Conclusions: The amount of CAC in patients with schizophrenia follows norm percentiles, and variables associated with the CAC score are similar in patients with schizophrenia and the general population. These findings indicate that the CAC score may not be sufficient to detect the risk of CHD in patients with schizophrenia. Future studies should explore other measures of subclinical CHD, including measures of peripheral atherosclerosis or cardiac autonomic neuropathy to improve early detection and intervention.

Trial registration: ClinicalTrials.gov Identifier: NCT02885792 , September 1, 2016.

Keywords: Coronary artery disease; Schizophrenia; Vascular Calcification.

Conflict of interest statement

TT and RA declare that they have no competing interests. SEJ has received an unrestricted research grant from the Obel Family Foundation. SG, JBF and CP declare that they have no competing interests. REN has received research grants from H. Lundbeck and Otsuka Pharmaceuticals for clinical trials, received speaking fees from Bristol-Myers Squibb, Astra Zeneca, Janssen & Cilag, Lundbeck, Servier, Otsuka Pharmaceuticals, Teva A/S and Eli Lilly and has acted as advisor to Astra Zeneca, Eli Lilly, Lundbeck, Otsuka Pharmaceuticals, Takeda and Medivir, and has acted as investigator for Janssen-Cilag, Lundbeck, Boehringer, Compass and Sage.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
The CAC scores in patients with schizophrenia represented on a logarithmic scale in relation to age-specific norm 50th, 75th and 90th percentiles divided by sex. Zero was added on the otherwise logarithmic y-axis to show the large amount of patients having a CAC score of zero. A Females B Males

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