Schizophrenia and Cardiac Problems: Tips for Improving Heart Health
Recently, I posted a blog entry on the high rates of cardiovascular disease among people with schizophrenia. A reader asked if improvements in lifestyle for a relative with schizophrenia can help improve this situation. While I can't point to a large body of research that shows lifestyle changes reverse the higher risk of cardiac problems associated with schizophrenia, there are some important points that can be made:
- People with schizophrenia have poor access to healthcare overall. This means that if you can get your relative to meet regular outpatient appointments with his or her primary care provider and get the tests the physician prescribes (for example, a stress EKG, an overnight sleep study, a cardiac catheterization), you have already overcome one of the biggest problems in improving cardiac health in people with schizophrenia.
- Often, people with schizophrenia don't take prescribed medication, including medication for diabetes and heart disease. This is a common finding throughout most of the research on schizophrenia. There have been amazing advances in treatment of heart disease, high blood pressure, and diabetes in the last 50 years, but these advances won't do much good for the patient if the doctor's advice isn't followed. This means that if your relative takes their prescribed psychiatric, cardiac, and other medication regularly as directed, they are doing a great deal to improve their health overall.
- Quitting smoking: People with schizophrenia smoke at a much higher rate than the general population, despite an overall trend of lower rates of smoking in this country. Smoking has a substantial negative impact on health, and in particular it can substantially worsen or increase the risk for heart disease. Nicotine also interacts with many medications in complicated ways, a discussion perhaps for a future blog. The good news is that there is some evidence that smoking cessation programs improve the chances of quitting over going cold turkey. The American Cancer Society is a great resource for locating a program in your area.
- Weight loss: Obesity is a major problem in the United States, and in particular in patients with schizophrenia who often take medications that cause substantial weight gain. Some research shows that weight management programs can help patients lose weight, but it is not clear whether weight loss is maintained in most patients or if this weight loss translates into lower mortality in patients with schizophrenia. There's little to be lost in asking a primary care physician if a consultation with a nutritionist would be warranted, particularly in patients who also have diabetes.
Helping patients with schizophrenia improve their cardiac health is a difficult challenge, but I can't stress enough the importance of quitting smoking on cardiac and overall health. A future blog can discuss the impact of nicotine use in patients with schizophrenia.