General Factors That Reduce Cardiovascular Risk in People With Schizophrenia: A Systematic Review

Background The life expectancy of individuals with schizophrenia in the United States is 20% shorter than that of the general population owing to cardiovascular disease (CVD). It is crucial to identify the factors that reduce CVD risk in these individuals. Objective In this systematic review, we examined the factors associated with CVD in people with schizophrenia. Methods We searched 3 electronic databases for English articles published before April 2023. Investigators assessed the factors associated with 2 cardiovascular health outcomes among people with schizophrenia: the 10-year coronary heart disease (CHD)/CVD risk and peak oxygen uptake (VO_2Peak/max). Results We retrieved 17 studies from the search. Investigators examined factors affecting 10-year CHD/CVD risk in 11 studies and VO_2Peak/max in 6 studies among people with schizophrenia. We found that individuals who had low metabolic symptoms (ie, hypertension and hyperglycemia), did not smoke, engaged in continuous CVD risk assessments, had a shorter duration of the diagnosis and hospitalization, and were of normal weight had a lower 10-year CHD/CVD risk. Furthermore, individuals who engaged in specific physical activity had a higher VO_2Peak/max. Finally, those taking antipsychotic medications had a higher 10-year CHD/CVD risk and a lower VO_2Peak/max. Conclusions The CVD risk factors observed in the general population are common among people with schizophrenia. When these risk factors are controlled, the 10-year CHD/CVD risk and VO_2Peak/max of these individuals may be improved. Given the elevated CVD risk associated with antipsychotic medications, future researchers should examine modifying CVD risk factors to mitigate the additional risks associated with medication use in this population.