Diabetes Metab J.  2024 Jan;48(1):122-133. 10.4093/dmj.2022.0431.

Psychotic Disorders and the Risk of Type 2 Diabetes Mellitus, Atherosclerotic Cardiovascular Diseases, and All-Cause Mortality: A Population-Based Matched Cohort Study

• Lee YB
• Kim H
• Lee J
• Kang D
• Kim G
• Jin SM
• Kim JH
• Jeon HJ
• Hur KY

• KMID: 2551268
• DOI: http://doi.org/10.4093/dmj.2022.0431

Abstract

Background
The effects of psychotic disorders on cardiometabolic diseases and premature death need to be determined in Asian populations.
Methods
In this population-based matched cohort study, the Korean National Health Insurance Service database (2002 to 2018) was used. The risk of type 2 diabetes mellitus (T2DM), acute myocardial infarction (AMI), ischemic stroke, composite of all cardiometabolic diseases, and all-cause death during follow-up was compared between individuals with psychotic disorders treated with antipsychotics (n=48,162) and 1:1 matched controls without psychiatric disorders among adults without cardiometabolic diseases before or within 3 months after baseline.
Results
In this cohort, 53,683 composite cases of all cardiometabolic diseases (during median 7.38 years), 899 AMI, and 1,216 ischemic stroke cases (during median 14.14 years), 7,686 T2DM cases (during median 13.26 years), and 7,092 deaths (during median 14.23 years) occurred. The risk of all outcomes was higher in subjects with psychotic disorders than matched controls (adjusted hazard ratios [95% confidence intervals]: 1.522 [1.446 to 1.602] for T2DM; 1.455 [1.251 to 1.693] for AMI; 1.568 [1.373 to 1.790] for ischemic stroke; 1.595 [1.565 to 1.626] for composite of all cardiometabolic diseases; and 2.747 [2.599 to 2.904] for all-cause mortality) during follow-up. Similar patterns of associations were maintained in subgroup analyses but more prominent in younger individuals (P for interaction <0.0001) when categorized as those aged 18–39, 40–64, or ≥65 years.
Conclusion
Patients with psychotic disorders treated with antipsychotics were associated with increased risk of premature allcause mortality and cardiometabolic outcomes in an Asian population. This relationship was more pronounced in younger individuals, especially aged 18 to 39 years.

Keyword

Diabetes mellitus, type 2; Ischemic stroke; Mortality; Myocardial infarction; Psychotic disorders

Figure

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  Fig. 1. Kaplan–Meier plots of the cumulative incidence of (A) composite of all cardiometabolic diseases, (B) acute myocardial infarction, (C) ischemic stroke, (D) type 2 diabetes mellitus, and (E) all-cause mortality during follow-up in patients with psychotic disorders treated with antipsychotics versus matched controls without major psychiatric disorders.

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  Fig. 2. Subgroup analyses for the hazard of (A) composite of all cardiometabolic diseases, (B) acute myocardial infarction, (C) ischemic stroke, (D) type 2 diabetes mellitus, and (E) all-cause mortality during follow-up in patients with psychotic disorders treated with antipsychotics versus matched controls without major psychiatric disorders. HR, hazard ratio; CI, confidence interval; CCI, Charlson comorbidity index.

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