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Lipid-modifying agents and risk of all-cause, natural and suicide mortality in schizophrenia: nationwide cohort study

Published online by Cambridge University Press:  16 May 2024

Pao-Huan Chen ,
Shang-Ying Tsai Open the ORCID record for Shang-Ying Tsai [Opens in a new window] ,
Po-Yu Chen ,
Chun-Hung Pan ,
Sheng-Siang Su ,
Chiao-Chicy Chen  and
Chian-Jue Kuo Open the ORCID record for Chian-Jue Kuo [Opens in a new window]
Pao-Huan Chen
Affiliation:
Department of Psychiatry, Taipei Medical University Hospital, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taiwan; and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
Shang-Ying Tsai
Affiliation:
Department of Psychiatry, Taipei Medical University Hospital, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taiwan; and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
Po-Yu Chen
Affiliation:
Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taiwan; and Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
Chun-Hung Pan
Affiliation:
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; and Department of Psychology, National Chengchi University, Taiwan
Sheng-Siang Su
Affiliation:
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
Chiao-Chicy Chen
Affiliation:
Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taiwan; and Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
Chian-Jue Kuo*
Affiliation:
Psychiatric Research Center, Taipei Medical University Hospital, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taiwan; and Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
*
Correspondence: Chian-Jue Kuo. Email: tcpckuo@seed.net.tw
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Abstract

Background

Individuals with schizophrenia face high mortality risks. The effects of lipid-modifying agents on this risk remain understudied.

Aim

This study was conducted to investigate the effects of lipid-modifying agents on mortality risk in people with schizophrenia.

Method

This nationwide cohort study collected the data of people with schizophrenia from Taiwan's National Health Insurance Research Database for the period between 1 January 2001 and 31 December 2019. Multivariable Cox proportional hazards regression with a time-dependent model was used to estimate the hazard ratio for mortality associated with each lipid-modifying agent.

Results

This study included 110 300 people with schizophrenia. Of them, 22 528 died (19 754 from natural causes and 1606 from suicide) during the study period, as confirmed using data from Taiwan's national mortality database. The use of lipid-modifying agents was associated with reduced risks of all-cause (adjusted hazard ratio [aHR]:0.37; P < 0.001) and natural (aHR:0.37; P < 0.001) mortality during a 5-year period. Among the lipid-modifying agents, statins and fibrates were associated with reduced risks of all-cause mortality (aHRs:0.37 and 0.39, respectively; P < 0.001 for both) and natural mortality (aHRs: 0.37 and 0.42, respectively; P < 0.001 for both). Notably, although our univariate analysis indicated an association between the use of lipid-modifying agents and a reduced risk of suicide mortality, the multivariate analysis revealed no significant association.

Conclusions

Lipid-modifying agents, particularly statins and fibrates, reduce the risk of mortality in people with schizophrenia. Appropriate use of lipid-modifying agents may bridge the mortality gap between these individuals and the general population.

Keywords

Schizophreniastandardised mortality ratiolipid-modifying agentstatinfibrate
Type
Original Article
Information
The British Journal of Psychiatry , First View , pp. 1 - 9
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Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press on behalf of Royal College of Psychiatrists

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