How Are Schizophrenia and Heart Disease Related?

Medically Reviewed by James Beckerman, MD, FACC on May 06, 2022
4 min read

More people with schizophrenia die from heart disease than from any other cause. This mirrors the pattern in the general population, where heart disease is also the top killer of both men and women. But people with serious mental illness, including schizophrenia, have an even higher risk than the general population, according to a 2022 study in the Journal of the American Heart Association. This translates to a life expectancy 10-25 years shorter than people without schizophrenia.

Schizophrenia is a serious mental illness with symptoms including hallucinations and delusions. The condition can be lifelong, but can be treated with medication and therapy. About 1% of the population has been diagnosed with schizophrenia.

The most common type of heart disease is coronary heart disease (CHD). It’s also called coronary artery disease (CAD). It happens when fatty plaque deposits build up in your arteries, blocking the normal flow of blood. Sometimes that leads to heart attacks.

The relationship between heart disease and schizophrenia is a complicated one. This is what researchers know so far:

Genetics

Genetics plays a big part in both schizophrenia and heart disease. Experts estimate that genes contribute about 80% of the risk for schizophrenia and 30%-60% of the risk for coronary heart disease. This helps explain why both conditions tend to run in families.

The question is whether the genes for these two conditions overlap. That would increase the risk of both conditions at once. The answer, so far, isn’t clear. A landmark 2013 study found several gene abnormalities linked to both schizophrenia and heart disease. But they stopped short of being able to prove that the same abnormalities are setting off both diseases.

Meanwhile, a March 2022 study didn’t find genetic relationships between schizophrenia and cardiovascular disease. But it did find that schizophrenia may increase the risk of heart failure.

Another possible explanation involves conditions at birth. If you were born prematurely, had a low birth weight, and your mother had poor nutrition when she was pregnant, you have higher risk for both heart disease and schizophrenia.

Biological factors

Scientists have also looked to various biological processes to help explain why people with schizophrenia have a greater risk for heart disease.

One possible explanation is that schizophrenia is linked with your body’s autonomic nervous system (ANS) not working properly. The ANS also controls:

  • Blood pressure
  • Heart rate
  • The health of blood vessels

Both heart disease and schizophrenia are also associated with higher levels of the stress hormone cortisol. Cortisol contributes to the process that makes plaque form in blood vessels, and to schizophrenia, depression, and anxiety disorders.

There’s also evidence that people with schizophrenia have higher levels of certain markers of inflammation. Chronic inflammation has been linked with cardiovascular disease and other diseases.

Antipsychotic medications

Antipsychotic medications commonly used to treat schizophrenia may increase heart disease risk.

If you take antipsychotics, you’re more likely to gain weight and develop diabetes, high blood pressure, and unhealthy cholesterol levels. All of these are major risk factors for cardiovascular disease.

People with schizophrenia who take antipsychotics for a longer time also have much higher rates of metabolic syndrome than people who have not been medicated – 53.5% versus 9.9%, according to one study. Metabolic syndrome is when you have at least three out of five conditions that increase your risk for not only heart disease but also diabetes and stroke. These conditions are:

  • High blood pressure
  • High blood sugar levels
  • Low HDL (“good”) cholesterol levels
  • High triglyceride levels
  • Large waist size

Researchers have also raised the possibility that antipsychotics can increase your risk of heart disease because they directly affect how your autonomic nervous system works.

If you need antipsychotic medications, you may face an uncomfortable trade-off when it comes to heart disease and drug side effects. The so-called second-generation atypical antipsychotics (SGAs) like olanzapine (Zyprexa) and quetiapine (Seroquel) are often used because they cut down on movement side effects like tremors. At the same time, they can make risk factors for heart disease – like weight gain and metabolic syndrome – worse.

Behavioral and lifestyle issues

People with schizophrenia and other serious mental illnesses are more likely to make lifestyle choices that increase the risk for heart disease. This includes:

  • Eating high-fat foods
  • Smoking
  • Drinking too much alcohol
  • Abusing drugs
  • Not enough exercise

The 2022 study in the Journal of the American Heart Association found that people with a serious mental illness such as schizophrenia were three times as likely to smoke and twice as likely to be extremely obese compared to people without the disease. People with schizophrenia also tend to have several different risk factors at once, which just raises the risk of heart disease.

Treatment challenges

Along with all these other factors, studies have shown that people with schizophrenia don’t get enough preventive care or treatment. They’re also less likely to take their medications as prescribed or to follow through with programs to help their hearts get better. Often, heart disease and other health conditions like high blood pressure and high cholesterol aren’t diagnosed at all.

The reasons for this extend from lack of access to health care and patients not being willing to get help. In some cases, another factor is a doctor’s lack of experience treating patients with serious mental disorders.

Even when a person with schizophrenia has a heart attack or stroke, they’re less likely to have procedures that would help them recover.

Because of medications and sometimes genetics, people with schizophrenia do face special challenges preventing heart disease. In general, though, the approach in avoiding heart disease is the same whether you have schizophrenia or not: lower your risk factors. For some people that means you should:

  • Lose extra weight
  • Stop smoking
  • Eat healthy foods
  • Exercise

Researchers say special efforts should be made to support prevention and treatment efforts in people with schizophrenia and other serious mental illnesses.

Show Sources

SOURCES:

BC Medical Journal: “Schizophrenia and coronary artery disease.”

Journal of the American Heart Association: “Cardiovascular Risk for Patients With and Without Schizophrenia, Schizoaffective Disorder, or Bipolar Disorder.”

Dialogues in Clinical Neuroscience: “The intriguing relationship between coronary heart disease and mental disorders.”

Nature Reviews Cardiology: “Cardiovascular disease in patients with severe mental illness.”

Mayo Clinic: “Schizophrenia.”

National Alliance on Mental Illness: “Schizophrenia.”

Schizophrenia Bulletin: “The Relationship Between Schizophrenia and Cardiovascular Disease: A Genetic Correlation and Multivariable Mendelian Randomization Study.”

Centers for Disease Control and Prevention: “Coronary Artery Disease (CAD)," “Heart Disease and Mental Health Disorders.”

The American Journal of Human Genetics: “Improved Detection of Common Variants Associated with Schizophrenia by Leveraging Pleiotropy with Cardiovascular-Disease Risk Factors.”

Journal of Psychiatry & Neuroscience: “Cardiac risk and schizophrenia.”

Merck Manual: “Overview of the Autonomic Nervous System.”

Cleveland Clinic: “Inflammation.”

American Heart Association: “About Metabolic Syndrome”

Agency for Healthcare Research and Quality: “Comparative Effectiveness of First and Second Generation Antipsychotics in the Adult Population.”

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