We have known for many years that people who suffer from schizophrenia die younger than expected, as much as 20 years younger than the general population. This appears unfair, and it was the inspiration of this work. Most people thought that this added risk of death was mostly due to the higher prevalence in schizophrenia of smoking, obesity and to other lifestyle differences.

For this reason, we recruited 40 patients with schizophrenia and an equal number of healthy controls, and scanned their hearts using a state-of-the-art approach, called cardiac magnetic resonance. This was performed at the state-of-the-art Robert Steiner MRI unit.

This figure, from our paper, shows the kind of images you get from cardiac MRI: panels A to C show how we measured the volume of the various heart chambers (RV = right ventricle; LV = left ventricle; the calliper in C) shows the width of the LV wall, called septum). Panels D to F show how we measured the speed profile of blood in the aorta (called pulse-wave velocity), the main outflow tract from the heart.

There is also a video we have made to showcase some of the cine sequences (short films) that can be obtained with cardiac MR:

Surprisingly, in our study we found that even after matching patients and healthy controls for age, sex, ethnicity and body mass index (BMI, deriving from height and weight); and after excluding any participants with any medical conditions, and other risk factors for heart disease, people with schizophrenia show hearts that are smaller and chunkier than controls. These changes are similar to those found in aging.

In a previous study we had also found that the muscle tissue in the hearts of people with schizophrenia shows changes seen in inflammatory conditions.
These heart changes have been shown to increase the risk of future heart disease, such as heart attacks and strokes.

This research has shown that schizophrenia is associated with heart changes, and that these changes could lead to an increase in the risk of heart disease and death in this group.
In future research we would like to check if these changes are genetically programmed, or if they are due to other illness-related factors, such as medication or chronicity.
Our long-term aim is to find ways to understand what underlies these changes and ultimately to reduce cardiovascular risk in people with schizophrenia.

Why I chose this article:

Osimo and colleagues go straight to the heart, using cardiac magnetic resonance imaging to explore the structure in 80 participants with schizophrenia. They found evidence of cardiac remodelling when compared with matched healthy controls, including smaller left and right ventricles and end-diastolic volumes, and increased concentricity and septal thicknesses. The findings persisted when adjusted for smoking and exercise levels, and were independent of antipsychotic medication dose or duration. Such remodelling occurs when myocytes are exposed to noxious stimuli, and the subsequent changes can be pathological. The authors note that these cardiac changes may be directly contributing to patient mortality.

Derek Tracy
Editor for Public Engagement and Education, BJPsych

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