Cardiovascular autonomic neuropathy in patients with schizophrenia

Abstract

Background

Cardiovascular autonomic neuropathy (CAN) is an independent predictor of cardiovascular disease (CVD) in patients with diabetes as well as in patients with pre-diabetes and metabolic syndrome. Patients with schizophrenia have an increased rate of metabolic syndrome, pre-diabetes and diabetes as compared to the general population. Despite of this, occurrence CAN has not been investigated in patient with schizophrenia. Therefore, the aims of this study were (1) to evaluate the feasibility testing for CAN with a new clinical tool and (2) report the prevalence of early and manifest CAN in patients with schizophrenia.

Methods and results

Patients with diagnosed schizophrenia and with a disease duration ≥10 years were matched 1:1 on age and gender at screening with psychiatric healthy controls. CAN was defined as ≥ two abnormal standard cardiovascular autonomic reflex tests (lying-to-standing, deep breathing, and Valsalva maneuver) using the Vagus^TM device. A total of 46 patients with schizophrenia were included and matched to psychiatric healthy controls. Manifest CAN were more frequently presented in patients with schizophrenia (39% vs. 6% for controls, p<.0001). Sensitivity analysis of 41 subjects with schizophrenia without diabetes matched to 41 psychiatric healthy controls, showed similar results (37% vs. 5% for controls, p<.0001).

Conclusion

CAN is highly prevalent in patients with schizophrenia. Testing for CAN is feasible and might be a new clinically tool for detecting early stages of CVD in patients with schizophrenia.

Keywords:

• Cardiovascular autonomic neuropathy
• cardiovascular autonomic reflex test
• heart rate variability
• schizophrenia

Disclosure statement

M.A.O. have no potential conflict of interest. E.W. have no potential conflict of interest. C.P. reports receiving a speaker honorarium from Lundbeck. J.F. is a co-inventor of the medical device Vagus™ and holds stocks in Medicus Engineering. J.B.V., J.A. and S.E.J. have no potential conflicts of interest. RE Nielsen has received research grants from H. Lundbeck and Otsuka Pharmaceuticals for clinical trials, received speaking fees from Bristol-Myers Squibb, Astra Zeneca, Janssen & Cilag, Lundbeck, Servier, Otsuka Pharmaceuticals, Teva A/S, and Eli Lilly and has acted as advisor to Astra Zeneca, Eli Lilly, Lundbeck, Otsuka Pharmaceuticals, Takeda, and Medivir, and has acted as investigator for Janssen-Cilag, Lundbeck, Boehringer, Compass and Sage.

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The study is funded by The Danish Heart Foundation, Brødrene Hartmann Foundation, Arvid Nielssons Foundation, and The Obel Family Foundation.

Notes on contributors

Emilie Sylvest Wieben

Emilie Wieben, MD and Senior House Officer at the Department of Psychiatry, Odense University hospital, Odense, Denmark.

Christoffer Polcwiartek

Christoffer Polcwiartek, MD, PhD fellow at the Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.

Jesper Fleischer

Jesper Fleischer, MSc in Biomedical Engineering, PhD, Associate professor at Institute of Clinical Medicine. He invented the Point-of-Care device, VAGUS, focusing on large-scale screening of cardiovascular autonomic neuropathy.

Jan Brink Valentin

Jan Brink Valentin, Senior Statistician at Danish Center for Clinical Health Services Research (DACS), Aalborg University, Denmark.

Jørgen Aagaard

Jørgen Aagaard, Former chief consultant, ass professor, Dr. Med in the research of psychiatry, Aalborg University, Denmark.

Svend Eggert Jensen

Svend Eggert Jensen, MD, PhD, Associate Professor with a history of working in the research of Cardiology in Psychiatry, Aalborg, Denmark.

René Ernst Nielsen

René Ernst Nielsen, MD, PhD Professor with a demonstrated history of working in the research industry. Skilled in Clinical Research, Medical Education, Epidemiology, Psychopharmacology, and Medicine.