Estimation Ten-Year Risk of Coronary Heart Disease in Patients with Schizophrenia

Discussion Committee: 
Prof. Waleed Sweileh Supervisor
Dr. Samah Al- Jabi/ Co-Supervisor
Dr. Nuha EL-Sharif /External Examiner
Dr. Adnane Sarhan/ Internal Examiner
Prof. Waleed Sweileh Supervisor
Dr. Samah Al- Jabi/ Co-Supervisor
Saqer M. Al-qoroum
Background: Studies indicated that patients with schizophrenia have shorter life span than that of general population. Objective: To estimate ten-year risk of coronary heart disease (CHD) in patients with schizophrenia. Methods: A cross-sectional study was carried out in four governmental primary psychiatric health care centers in northern West-Bank (Nablus, Jenin, Qalqilia, and Tulkarem). 112 patients diagnosed with schizophrenia were recruited for the study. A convenience, non-probability sampling method was used. Ten-year risk of CHD was calculated using Framingham risk scoring formula which includes the following variables: age, gender, smoking status, high-density lipoprotein- cholesterol, systolic blood pressure and history of anti-hypertensive drugs hypertension. Risk of CHD was categorized based on total scores into the followings: Ideal (<5%), low (5-9%), intermediate (10-20%) and high (>20%). Descriptive and analytical statistics was conducted using Statistical Package for Social Sciences (SPSS) version 20. Results: The mean age of the participants was 43 ± 10.85 years. The majority were males (76; 67%). There was no significant difference between males and females in age (P=0.72), duration of psychiatric illness (P=0.085), systolic blood pressure (P=0.75), diastolic blood pressure (P=0.7) and total cholesterol level (P=0.17). The mean ± standard deviation (SD) ten-year CHD risk score was 5.6 ± 5.8 (median (inter quartile range (Q1 – Q3)): 3 (1 – 9)). The mean ± SD ten-year CHD risk score for females was 1.5 ± 1.58 (median (Q1 – Q3): 0.75 (0.5 – 2)) while that for males was 7.5 ± 6 (median (Q1-Q3): 6 (2–13)). Based on Framingham risk scores, there were 87 (77.7%) patients in low risk, 22 (19.6%) patients in intermediate risk and 3 (2.7%) patients in high risk. Univariate analysis showed that there were significant differences between low <10% risk score and intermediate/high risk ≥ 10% risk score categories with respect to age distribution (P<0.05), gender (P<0.05), smoking (P<0.05), total cholesterol (P<0.05), diastolic blood pressure (P<0.05) and duration of psychiatric illness (P=0.03). However, there was no significant difference between the low <10% and intermediate/high ≥10% categories in terms of systolic blood pressure, waist circumference and HDL-C levels. Multivariate analysis on male patients showed that age [O.R=1.524, 95% CI (1.213-1.914)] and diastolic BP [O.R=1.207, 95% CI (1.045-1.393)] were significant factors associated with intermediate/high ≥ 10% CHD risk. Conclusions: One fifth of schizophrenia patients had a CHD risk ≥ 10%. Efforts to decrease CHD risks among patients with schizophrenia should be directed mainly toward diastolic BP as modifiable risk factor. Key words: Schizophrenia, Framingham Risk Score, CHD, Palestine
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