Primary prevention of cardiovascular events in patients with major mental illness: a possible role for statins

Authors

  • Chittaranjan Andrade

    Corresponding author
    1. Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India
    • Corresponding author:

      Chittaranjan Andrade, M.D.

      Department of Psychopharmacology

      National Institute of Mental Health and Neurosciences

      Bangalore 560 029

      India

      Fax: +91-80-26564830

      E-mail: andradec@gmail.com

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Abstract

Objectives

To examine the need for and the possible benefits and risks of statin therapy in patients with major mental illness.

Methods

Patients with psychiatric conditions, especially those with major mental illnesses such as schizophrenia and bipolar disorder, are at increased risk of overweight, obesity, dyslipidemia, diabetes mellitus, and the metabolic syndrome, all of which increase the risk of cardiovascular disease, cerebrovascular disease, and mortality. The literature on the subject was qualitatively reviewed.

Results

Primary prevention benefits with statins are well known in the general population of high-risk patients; recent evidence suggests that statins also carry primary prevention benefits in low-risk subjects. Regrettably, the primary prevention of cardiovascular and cerebrovascular events in psychiatry is a neglected area in clinical practice as well as in interventional research, whether in high- or in low-risk patients. Initial concerns notwithstanding, psychiatric complications do not appear to be important among the adverse effects of statins. Although statins are associated with an increased risk of incident diabetes mellitus, myopathy, and other untoward consequences, the risk–benefit ratio appears to favor statin use. The advisability of using statins in low-risk or medically healthy subjects remains debatable.

Conclusions

Overweight, obesity, dyslipidemia, diabetes mellitus, and the metabolic syndrome are common in patients with major mental illness, and these increase the risk of medical morbidity and mortality. Statin use should therefore be considered for the primary prevention of cardiovascular and cerebrovascular events in psychiatric patients, especially in those at high risk.

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