Elevated risk of cardiovascular disease in patients with schizophrenia: a systematic review and meta-analysis
G Medina Avalos, J A Gonzalez Gomez, O Saenz Lopez, D Casanova Campos, M A Verber Arano, V Castillo Bringas, A Perez Perez, A Jordan RiosAbstract
Background
Schizophrenia is a severe chronic mental illness affecting approximately 1% of the global population and is associated with excess mortality, largely driven by cardiovascular disease. Observational evidence suggests that individuals with schizophrenia have a higher risk of cardiovascular events compared with the general population, but the magnitude of this association remains incompletely understood. In addition, potential sex differences in this relationship have not been clearly established.
Purpose
This study aimed to conduct a systematic review and meta-analysis to evaluate the risk of adverse cardiovascular outcomes in patients with schizophrenia compared with individuals without the condition, and to examine potential sex differences in these associations.
Methods
A comprehensive search of major databases was conducted up to February 2026 to identify observational studies comparing individuals with schizophrenia to those without the condition. Meta-analysis inclusion criteria followed Cochrane guidelines. A random-effects model was employed for the meta-analysis to calculate hazard ratios (HRs) with 95% confidence intervals (CIs).
Results
A total of fourteen observational studies met the inclusion criteria, encompassing 13,960,780 participants, of whom 161,212 had a diagnosis of schizophrenia. Overall, 60.9% were male, with a median follow-up of 5.85 years. Schizophrenia was associated with a higher risk of all cardiovascular outcomes. The pooled HR was 1.95 (95% CI 1.77–2.15) for heart failure, 1.38 (1.09–1.74) for atrial fibrillation, 1.41 (1.27–1.57) for myocardial infarction, and 1.93 (1.59–2.35) for stroke. Sex differences were observed for atrial fibrillation and myocardial infarction, with a stronger association in women, while no significant differences were found for heart failure or stroke.
Conclusions
This meta-analysis suggests a potential need for targeted cardiovascular screening and prevention strategies in patients with schizophrenia. However, the observed heterogeneity highlights the importance of further large, prospective studies to clarify underlying mechanisms, define risk thresholds, and confirm sex-specific differences.Forestplot-schizo1.jpeg