Physical health and attendance at primary care in people with schizophrenia

2008 ◽  
Vol 25 (2) ◽  
pp. 57-60 ◽  
Author(s):  
Caragh Behan ◽  
Nicola McGlade ◽  
Farhan Haq ◽  
Anthony Kinsella ◽  
Michael Gill ◽  
...  

AbstractObjectives: People with schizophrenia are at increased risk of cardiovascular and endocrine disease. National guidelines recommend the physical health of people with schizophrenia be monitored by primary care, but little is known about whether such people attend primary care. We sought to examine the prevalence of cardiovascular and endocrine disease in a stable population with schizophrenia, and factors associated with attending primary care.Method: A cross sectional survey of people with a diagnosis of schizophrenia/schizoaffective disorder was taken from a larger cohort participating in the Resource for Psychoses and Genomics in Ireland (RPGI) study. Participants were interviewed using standardised clinical assessments, and underwent anthropometric measurements, and further information was collected by medical record review and contacting the general practitioner (GP).Results: Thirteen percent (n = 14) had established cardiovascular disease and 4.3% (n = 4) had type 2 diabetes. Risk factors for cardiovascular disease and type 2 diabetes were higher than the general population. Sixty-eight point five percent (n = 63) had attended their GP at least once in the previous year. Only 35% self reported a physical illness. Females (p = 0.03), those with both self-reported presence of physical illness (p = 0.007), and diagnosed physical illness (p = 0.001) were more likely to attend their GP. Other psychosocial, psychological and illness related variables did not predict attendance at primary care.Conclusion: While established patients attend their GP, they had significant unidentified risk factors for cardiovascular disease and type 2 diabetes. It is likely that non-attendees at secondary care would fare worse yet.

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031281 ◽  
Author(s):  
Manel Mata-Cases ◽  
Josep Franch-Nadal ◽  
Jordi Real ◽  
Marta Cedenilla ◽  
Didac Mauricio

ObjectivesTo evaluate the prevalence and coprevalence of several chronic conditions in patients with type 2 diabetes in a Mediterranean region.DesignA cross-sectional study.SettingTwo hundred and eighty-six primary care teams of the Catalonian Health Institute (Catalonia, Spain).ParticipantsWe included patients aged ≥18 years with a diagnosis of type 2 diabetes by 31 December, 2016, who were registered in the Information System for the Development of Research in primary care (SIDIAP) database. We excluded patients with a diagnosis of type 1 diabetes, gestational diabetes mellitus and any other type of diabetes.Primary and secondary outcome measuresWe collected data on diabetes-related comorbidities (ie, chronic complications, associated cardiovascular risk factors and treatment complications). Diagnoses were based on the International Classification of Diseases, 10thRevision codes recorded in the database or, for some entities, on the cut-off points for a particular test result or a specific treatment indicated for that entity. The presence and stage of chronic kidney disease (CKD) were based on the glomerular filtration rate, the CKD Epidemiology Collaboration creatinine equation and the urine albumin-to-creatinine ratio.ResultsA total of 373 185 patients were analysed. 82% of patients exhibited ≥2 comorbidities and 31% exhibited ≥4 comorbidities. The most frequent comorbidities were hypertension (72%), hyperlipidaemia (60%), obesity (45%), CKD (33%), chronic renal failure (CRF)(28%) and cardiovascular disease (23%). The most frequently coprevalent pairs of chronic conditions were the combination of hypertension with hyperlipidaemia (45%), obesity (35%), CKD (28%), CRF (25%) or cardiovascular disease (19%), as well as the combination of hyperlipidaemia with obesity (28%), CKD (21%), CRF (18%) or cardiovascular disease (15%); other common pairs of comorbidities were obesity/CKD, obesity/CRF, hypertension/retinopathy, hypertension/albuminuria, hypertension/urinary tract infection, CVD/CRF and CVD/CKD, which were each present in more than 10% of patients.ConclusionPatients with type 2 diabetes have a high frequency of coprevalence of metabolic risk factors, cardiovascular disease and CKD and thus require an integrated management approach.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H.B Oestergaard ◽  
M.C Verhaar ◽  
M.L Bots ◽  
F.W Asselbergs ◽  
G.J De Borst ◽  
...  

Abstract Background Patients with cardiovascular disease are at increased risk of developing chronic kidney disease, potentially leading to end-stage kidney disease (ESKD). On the other hand, kidney disease is associated with an increased risk of adverse cardiovascular outcomes and mortality. Previous studies have identified several risk factors for ESKD in the general population. However, little is known about the impact of these risk factors for ESKD in patients with clinically manifest cardiovascular disease. Purpose The aim of this study was to determine the incidence rates of ESKD in patients with clinically manifest cardiovascular disease and to assess the relation between risk of ESKD and risk factors, including systolic blood pressure (SBP), type 2 diabetes mellitus, estimated glomerular filtration rate (eGFR) and albuminuria (urinary albumin/creatinine ratio (uACR)), body mass index (BMI), dyslipidemia (non-HDL cholesterol), smoking, kidney length and exercise, in this high-risk population. Methods Patients (n=8402) from the ongoing UCC-SMART cohort (1996–2018) with clinically manifest cardiovascular disease were included. Occurrence of ESKD during follow up was defined as kidney transplantation, chronic dialysis or chronic kidney disease stage 5 (persistent eGFR <15 mL/min/1.73m2). Incidence rates for ESKD were determined and stratified according to vascular disease location. Cox proportional hazard models were used to assess the risk of ESKD for every determinant adjusted for potential confounders. Results A total of 65 events of ESKD were observed in 75,282 person-years (median follow-up time 8.6 years, IQR 4.7–12.8 years). The overall incidence rate for ESKD was 0.9 per 1000 person-years and was lower in patients with only cerebrovascular (0.6 per 1000 person-years) or cardiovascular disease (0.6 per 1000 person-years). A higher incidence rate was observed in patients with polyvascular disease (1.8 per 1000 person-years) (Figure 1A). Presence of type 2 diabetes (HR 1.83; 95% CI 1.06–3.16) and higher SBP (HR 1.37; 95% CI 1.24–1.52 per 10 mmHg) were associated with an elevated risk of ESKD. Lower eGFR and higher uACR were associated with a higher risk of ESKD (Figure 1B). Kidney length was inversely associated with risk of ESKD. Smoking, physical exercise, BMI and non-HDL cholesterol were not related to ESKD. Conclusions The incidence of ESKD is higher in patients with polyvascular disease compared to patients with cerebrovascular or cardiovascular disease. Type 2 diabetes, SBP, eGFR, uACR and kidney length are associated with a higher risk of ESKD. In patients with symptomatic vascular disease, secondary cardiovascular prevention focused at these risk factors may also reduce the risk of ESKD. Figure 1 Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): University Medical Center Utrecht


2020 ◽  
Author(s):  
Pham Viet Thai ◽  
Hoang Anh Tien ◽  
Huynh Van Minh ◽  
Paul Valensi

Abstract Background Triglyceride Glucose index (TyG) was associated with an increased risk of cardiovascular events. Silent coronary disease is common in patients with type 2 diabetes. In Vietnam, a low-middle income country, the burden of cardiovascular disease is growing in parallel to the epidemiologic transition. The aim was in patients with type 2 diabetes and no history or symptom of cardiovascular disease, to assess the prevalence of coronary stenoses (CS) and investigate the association between TyG and cardiovascular risk factors and the presence and severity of CS. Methods We recruited 166 patients at Ninh Thuan General Hospital, Vietnam. TyG and HOMA-IR were calculated, and a coronary computed tomography angiography (CCTA) was performed. Results The population was separated according to tertiles of TyG. Patients with highest TyG had higher BMI, waist circumference, total cholesterol, LDL-cholesterol, triglycerides, plasma glucose and HbA1c levels, lower HDL-cholesterol; more of them had a metabolic syndrome and less practiced physical activity (p<0.05 to <0.001). TyG correlated with HOMA-IR (p<0.001). CS ≥50% were present in 60 patients, with a coronary artery narrowing ≥70% in 32 of them. The patients with CS had higher TyG (p<0.05). The association of TyG with CS remained significant in a multivariate analysis including confounding risk factors. The number of narrowed vessels and the degree of stenosis were associated with higher TyG levels (p=0.04 and <0.005). TyG was significant in identifying patients with CS with an area under the ROC curve of 0.678 (95%CI: 0.582-0.775, p=0.002), a cut-off point of 9.63 offering 75% sensitivity and 44% specificity. In subgroup analysis the association TyG-CS was stronger in patients ≥60 yrs, with HbA1c≥7%, on statin or anti-platelet therapy. The AROC was higher with the triple criterion age-HbA1c-TyG than with age or HbA1c alone (p<0.001 for both comparisons). Conclusion More than one third of asymptomatic patients with type 2 diabetes had CS on CCTA. TyG may be considered as a marker of insulin resistance and allows to identify patients with high risk of coronary stenoses, particularly in those ≥ 60 yrs with poor glycemic control, and is associated with the number and the severity of narrowed branches.


Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1655-P
Author(s):  
SOO HEON KWAK ◽  
JOSEP M. MERCADER ◽  
AARON LEONG ◽  
BIANCA PORNEALA ◽  
PEITAO WU ◽  
...  

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