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Cardiovascular effects of psychotic illnesses and antipsychotic therapy
  1. Sandra Howell1,
  2. Ekaterina Yarovova1,2,
  3. Ahmad Khwanda3,
  4. Stuart D Rosen1,4
  1. 1 Cardiology, Ealing Hospital, London North West University Healthcare NHS Trust, Middlesex, UK
  2. 2 Faculty of Medicine, Imperial College London, London, UK
  3. 3 Cardiology, King's College Hospital NHS Foundation Trust, London, UK
  4. 4 Imperial College, National Heart and Lung Institute Division of Cardiovascular Sciences, London, UK
  1. Correspondence to Dr Stuart D Rosen, Imperial College, National Heart and Lung Institute Division of Cardiovascular Sciences, London, SW7 2AZ, UK; stuart.rosen{at}


Mortality from cardiovascular disease is increased in people with mental health disorders in general and schizophrenia in particular. The causes are multifactorial, but it is known that antipsychotic medication can cause cardiac side-effects beyond the traditional coronary risk factors. Schizophrenia itself is a contributor to an increased risk of cardiovascular mortality via cardiac autonomic dysfunction and a higher prevalence of metabolic syndrome, both contributing to a reduced life expectancy. The pro-arrhythmic impact of traditional antipsychotics, especially via the hERG-potassium channel, has been known for several years. Newer antipsychotics have a reduced pro-arrhythmic profile but might contribute to higher cardiac death rates by worsening the metabolic profile. Clozapine-induced cardiomyopathy, which is dose independent, is a further concern and continuous monitoring of these patients is required. Prophylaxis with angiotensin-converting enzyme inhibitors is currently under review. Overall, management of cardiovascular risk within this population group must be multifaceted and nuanced to allow the most effective treatment of serious mental illness to be conducted within acceptable parameters of cardiovascular risk; some practical measures are presented for the clinical cardiologist.

  • cardiac risk factors and prevention
  • electrophysiology
  • metabolic syndrome
  • metabolic heart disease
  • drug interactions

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  • Contributors All the four authors contributed to this manuscript in terms of researching the material, drafting sections and creating the figures and table. The senior author (SDR) additionally brought together the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.