Aims: It remains unclear whether young patients with mental disorders have a higher risk of cardiovascular diseases than does the general population. Using a nationwide database, we investigated the prognostic association between the risks of myocardial infarction (MI), ischaemic stroke (IS), and mental disorders in young patients.
Methods and results: Young patients aged between 20 and 39 years old who underwent nationwide health examinations between 2009 and 2012 were screened. A total of 6 557 727 individuals were identified and subsequently classified according to mental disorders including depressive disorder, bipolar disorder, schizophrenia, insomnia, anxiety disorder, post-traumatic stress disorder, personality disorder, somatoform disorder, eating disorder, and substance use disorder. Patients were then followed up for MI and IS until December 2018. Patients with mental disorders did not show unfavourable lifestyle behaviours or worse metabolic profiles than their counterparts. During the follow-up period (median, 7.6 years; interquartile range, 6.5-8.3), 16 133 cases of MI and 10 509 cases of IS occurred. Patients with mental disorders had higher risks of MI (log-rank P = 0.033 in eating disorder and log-rank P < 0.001 in all other mental disorders). Patients with mental disorders had higher risks of IS except post-traumatic stress disorder (log-rank P = 0.119) and eating disorder (log-rank P = 0.828). After adjusting for covariates, the overall diagnosis and each mental disorder were independently associated with increased cardiovascular endpoints.
Conclusion: Mental disorders in young patients may have deleterious effects which increase the incidence of MI and IS. Prevention efforts are needed to prevent MI and IS in young patients with mental disorders.
Keywords: Ischaemic stroke; Mental disorders; Myocardial infarction; Prognosis.
Although young patients with mental disorders did not show worse baseline characteristics in this nationwide study, mental disorders in young patients have deleterious effects on the incidence of both myocardial infarction (MI) and ischaemic stroke (IS) events, across depressive disorder, bipolar disorder, schizophrenia, insomnia, anxiety disorders, post-traumatic stress disorder, personality disorder, somatoform disorder, eating disorder, and substance use disorder. Patients with mental disorders are known to have a shorter life expectancy across schizophrenia, affective disorders, and other mental disorders than the general population; previous study verified that around 70% of deaths in those with mental disorders were due to physical diseases. If patients with mental disorders have higher risks of cardiovascular diseases, especially in young patients, prevention and surveillance of cardiovascular diseases among these young patients during their lifetime should be considered.A substantial number of young patients aged 20–39 years (13.1%) were diagnosed with mental disorders, and excessive risks of incident MI and IS were observed in patients with mental disorders including depressive disorder, bipolar disorder, schizophrenia, insomnia, anxiety disorder, post-traumatic stress disorder, personality disorder, somatoform disorder, eating disorder, and substance use disorder. In contrast to previous suggestion that unfavourable lifestyle behaviours and poor cardiometabolic profiles could lead to increased cardiovascular risks, patients with mental disorders did not show unfavourable lifestyle behaviours or worse metabolic profiles than their counterparts.
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