Cardiovascular Autonomic Reflex Tests Using a Handheld Device in the Diagnosis of Cardiovascular Autonomic Neuropathy in Patients with Schizophrenia

Overview

Journal Am Heart J Plus

Specialty Cardiology & Vascular Diseases

Date 2024 Mar 21

PMID 38510185

Authors

Laura Blok-Husum

Milka Ane Rank Brcelic

Hanin Kawa Farman Kawal Bassi

Svend Eggert Jensen

Rene Ernst Nielsen

Kristian Kragholm

Jesper Fleischer

Esben Laugesen

Christoffer Polcwiartek

Affiliations

Soon will be listed here.

Abstract

Study Objective: This study investigated whether schizophrenia and the duration of schizophrenia were associated with cardiovascular autonomic neuropathy (CAN) by using heart rate variability (HRV) as a marker.

Design: Cross-sectional study.

Setting: The examinations were conducted at the Centre for Psychosis Research and at the Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.

Participants: 240 patients with first-episode and chronic schizophrenia and 180 controls.

Interventions: CAN was assessed by the cardiovascular reflex tests (CARTs): HR, RS ratio, E:I ratio, and VM using a handheld device.

Main Outcome Measures: One abnormal CART was interpreted as borderline CAN and ≥2 abnormal CARTs established definitive CAN. Borderline CAN and definitive CAN together was categorized as overall CAN. Analyses were adjusted for age, sex, smoking, overweight, and hypercholesterolemia.

Results: A total of 240 patients with schizophrenia (median age 42.5 [28.8, 52.3], 42.9 % women) and 180 controls (median age 45.8 [24.0, 60.1], 47.8 % women) were included, with 50.8 % of patients with schizophrenia having overall CAN compared to 27.2 % among controls. Dividing patients into patients with first-episode and chronic schizophrenia, 32.9 % vs 10 % ( < 0.001) and 59.1 % vs 41 % (p < 0.001) had overall CAN compared with controls, respectively. Schizophrenia was significantly associated with overall CAN (OR, 2.80; 95%CI, 1.75-4.50), with an OR of 2.31 (95%CI, 1.14-4.68) for first-episode schizophrenia and an OR of 2.97 (95%CI, 1.81-4.87) for chronic schizophrenia.

Conclusion: It was demonstrated that a diagnosis of schizophrenia was associated with CAN. Patients with chronic schizophrenia had a significantly higher prevalence of CAN compared to patients with first-episode schizophrenia, suggesting an association between the duration of schizophrenia and CAN.

Citing Articles

Severe mental illness: cardiovascular risk assessment and management.

Polcwiartek C, OGallagher K, Friedman D, Correll C, Solmi M, Jensen S Eur Heart J. 2024; 45(12):987-997.

PMID: 38538149 PMC: 10972692. DOI: 10.1093/eurheartj/ehae054.

References

Henderson D, Vincenzi B, Andrea N, Ulloa M, Copeland P . Pathophysiological mechanisms of increased cardiometabolic risk in people with schizophrenia and other severe mental illnesses. Lancet Psychiatry. 2015; 2(5):452-464. DOI: 10.1016/S2215-0366(15)00115-7. View

Emul M, Kalelioglu T . Etiology of cardiovascular disease in patients with schizophrenia: current perspectives. Neuropsychiatr Dis Treat. 2015; 11:2493-503. PMC: 4599145. DOI: 10.2147/NDT.S50006. View

Andersen S, Witte D, Fleischer J, Andersen H, Lauritzen T, Jorgensen M . Risk Factors for the Presence and Progression of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes: ADDITION-Denmark. Diabetes Care. 2018; 41(12):2586-2594. DOI: 10.2337/dc18-1411. View

Bissinger A . Cardiac Autonomic Neuropathy: Why Should Cardiologists Care about That?. J Diabetes Res. 2017; 2017:5374176. PMC: 5682059. DOI: 10.1155/2017/5374176. View

Bar K, Letzsch A, Jochum T, Wagner G, Greiner W, Sauer H . Loss of efferent vagal activity in acute schizophrenia. J Psychiatr Res. 2005; 39(5):519-27. DOI: 10.1016/j.jpsychires.2004.12.007. View

Hagen J, Sutterland A, Koeter M, Lutter R, Cohen D, de Haan L . Advanced Glycation End Products in Recent-Onset Psychosis Indicate Early Onset of Cardiovascular Risk. J Clin Psychiatry. 2017; 78(9):1395-1401. DOI: 10.4088/JCP.16m10972. View

Jung W, Jang K, Lee S . Heart and Brain Interaction of Psychiatric Illness: A Review Focused on Heart Rate Variability, Cognitive Function, and Quantitative Electroencephalography. Clin Psychopharmacol Neurosci. 2019; 17(4):459-474. PMC: 6852682. DOI: 10.9758/cpn.2019.17.4.459. View

Seifarth C, Schehler B, Schneider H . Effectiveness of metformin on weight loss in non-diabetic individuals with obesity. Exp Clin Endocrinol Diabetes. 2012; 121(1):27-31. DOI: 10.1055/s-0032-1327734. View

Attar R, Johansen M, Valentin J, Aagaard J, Jensen S . Treatment following myocardial infarction in patients with schizophrenia. PLoS One. 2017; 12(12):e0189289. PMC: 5728533. DOI: 10.1371/journal.pone.0189289. View

10.

Nielsen R, Banner J, Jensen S . Cardiovascular disease in patients with severe mental illness. Nat Rev Cardiol. 2020; 18(2):136-145. DOI: 10.1038/s41569-020-00463-7. View

11.

Gulichsen E, Fleischer J, Ejskjaer N, Eldrup E, Tarnow L . Screening for diabetic cardiac autonomic neuropathy using a new handheld device. J Diabetes Sci Technol. 2012; 6(4):965-72. PMC: 3440170. DOI: 10.1177/193229681200600430. View

12.

Polcwiartek C, Atwater B, Kragholm K, Friedman D, Barcella C, Attar R . Association Between ECG Abnormalities and Fatal Cardiovascular Disease Among Patients With and Without Severe Mental Illness. J Am Heart Assoc. 2021; 10(2):e019416. PMC: 7955293. DOI: 10.1161/JAHA.120.019416. View

13.

Nielsen R, Uggerby A, Jensen S, McGrath J . Increasing mortality gap for patients diagnosed with schizophrenia over the last three decades--a Danish nationwide study from 1980 to 2010. Schizophr Res. 2013; 146(1-3):22-7. DOI: 10.1016/j.schres.2013.02.025. View

14.

Fan Z, Wu Y, Shen J, Ji T, Zhan R . Schizophrenia and the risk of cardiovascular diseases: a meta-analysis of thirteen cohort studies. J Psychiatr Res. 2013; 47(11):1549-56. DOI: 10.1016/j.jpsychires.2013.07.011. View

15.

Lomholt L, Andersen D, Sejrsgaard-Jacobsen C, Ozdemir C, Graff C, Schjerning O . Mortality rate trends in patients diagnosed with schizophrenia or bipolar disorder: a nationwide study with 20 years of follow-up. Int J Bipolar Disord. 2019; 7(1):6. PMC: 6395457. DOI: 10.1186/s40345-018-0140-x. View

16.

Fleischer J, Nielsen R, Laugesen E, Nygaard H, Poulsen P, Ejskjaer N . Self-monitoring of cardiac autonomic function at home is feasible. J Diabetes Sci Technol. 2011; 5(1):107-12. PMC: 3045244. DOI: 10.1177/193229681100500115. View

17.

Fujibayashi M, Matsumoto T, Kishida I, Kimura T, Ishii C, Ishii N . Autonomic nervous system activity and psychiatric severity in schizophrenia. Psychiatry Clin Neurosci. 2009; 63(4):538-45. DOI: 10.1111/j.1440-1819.2009.01983.x. View

18.

Chung M, Yang A, Lin Y, Lin C, Chang F, Shen S . Association of altered cardiac autonomic function with psychopathology and metabolic profiles in schizophrenia. Psychiatry Res. 2013; 210(3):710-5. DOI: 10.1016/j.psychres.2013.07.034. View

19.

Vinik A, Ziegler D . Diabetic cardiovascular autonomic neuropathy. Circulation. 2007; 115(3):387-97. DOI: 10.1161/CIRCULATIONAHA.106.634949. View

20.

Yerevanian A, Soukas A . Metformin: Mechanisms in Human Obesity and Weight Loss. Curr Obes Rep. 2019; 8(2):156-164. PMC: 6520185. DOI: 10.1007/s13679-019-00335-3. View