Long JF, Deng LM, Zhang JD, Tang ZJ, Zhou K. Risk characteristics of obesity and atherosclerotic cardiovascular events in patients with schizophrenia: A single-center 10-year retrospective cohort study. World J Psychiatry 2026; 16(4): 114138 [DOI: 10.5498/wjp.v16.i4.114138]
Corresponding Author of This Article
Kang Zhou, MD, Associate Professor, Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Middle Road, Changsha 410011, Hunan Province, China. kang.zhou@csu.edu.cn
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Psychiatry
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Retrospective Cohort Study
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Apr 19, 2026 (publication date) through Mar 30, 2026
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World Journal of Psychiatry
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2220-3206
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Long JF, Deng LM, Zhang JD, Tang ZJ, Zhou K. Risk characteristics of obesity and atherosclerotic cardiovascular events in patients with schizophrenia: A single-center 10-year retrospective cohort study. World J Psychiatry 2026; 16(4): 114138 [DOI: 10.5498/wjp.v16.i4.114138]
World J Psychiatry. Apr 19, 2026; 16(4): 114138 Published online Apr 19, 2026. doi: 10.5498/wjp.v16.i4.114138
Risk characteristics of obesity and atherosclerotic cardiovascular events in patients with schizophrenia: A single-center 10-year retrospective cohort study
Jian-Feng Long, Li-Min Deng, Jian-Dong Zhang, Zhen-Jie Tang, Kang Zhou
Jian-Feng Long, Li-Min Deng, Department of Clinical Nutrition, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Jian-Dong Zhang, Department of Internal Medicine, Yantai Fushun Hospital, Yantai 264011, Shandong Province, China
Zhen-Jie Tang, Kang Zhou, Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Author contributions: Long JF and Deng LM contributed to study conception and design, data collection, and manuscript drafting; Zhang JD participated in data acquisition and statistical analysis; Tang ZJ contributed to interpretation of cardiovascular data and critical manuscript revision; Zhou K provided clinical guidance, supervised the overall project, and revised the manuscript for important intellectual content. All authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of The Second Xiangya Second Hospital of Central South University (approval No. 2025-030).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data is available.
Corresponding author: Kang Zhou, MD, Associate Professor, Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Middle Road, Changsha 410011, Hunan Province, China. kang.zhou@csu.edu.cn
Received: October 14, 2025 Revised: November 9, 2025 Accepted: December 19, 2025 Published online: April 19, 2026 Processing time: 166 Days and 19.5 Hours
Abstract
BACKGROUND
Patients with schizophrenia experience a significantly elevated risk of cardiovascular disease and premature mortality compared with the general population. This excess burden is largely attributable to modifiable metabolic factors, including obesity, diabetes, dyslipidemia, and hypertension, which occur at disproportionately high rates in this population. Antipsychotic medications, particularly second-generation agents, further exacerbate weight gain and metabolic dysfunction, whereas lifestyle factors such as smoking, sedentary behavior, and poor diet contribute as additional risk factors. Despite guideline recommendations for routine monitoring, cardiovascular risk assessments and preventive strategies remain underutilized in psychiatric settings, leaving patients vulnerable to avoidable morbidity and early death.
AIM
To characterize 10-year risk profiles of obesity and atherosclerotic cardiovascular events in large single-center cohort of patients with schizophrenia.
METHODS
This single-center retrospective cohort study analyzed 10000 patients with schizophrenia spectrum disorders treated at the Second Xiangya Hospital of Central South University, a tertiary psychiatric hospital in Changsha, China, from January 2015 to December 2024. We assessed metabolic parameters, cardiovascular risk factors, and incidence of atherosclerotic cardiovascular events. The primary outcomes were prevalence of obesity, metabolic syndrome, and 10-year cardiovascular risk scores. The secondary outcomes included incident cardiovascular events and all-cause mortality.
RESULTS
Among 10000 patients (mean age 42.3 ± 13.5 years, 58.2% male), the prevalence of obesity was 43.7%, metabolic syndrome 38.9%, and diabetes 18.4%. The mean 10-year cardiovascular risk score was 12.8% ± 8.3%. During follow-up, 1842 patients (18.4%) experienced major adverse cardiovascular events, with significantly higher rates in obese patients (hazard ratio: 2.34, 95% confidence interval: 2.11-2.59, P < 0.001). Antipsychotic polypharmacy and illness duration were independent predictors of increased cardiovascular risk.
CONCLUSION
A substantially elevated cardiovascular risk was observed in patients with schizophrenia. Integrated care approaches incorporating metabolic monitoring and lifestyle interventions are required to address health disparities in this patient population.
Core Tip: This 10-year retrospective cohort study investigated the association between obesity and atherosclerotic cardiovascular events in patients with schizophrenia. These findings highlight that obesity significantly increases cardiovascular risk in this vulnerable population, influenced by both antipsychotic treatment and lifestyle factors. Early identification and comprehensive management of metabolic abnormalities are essential to reduce morbidity and mortality. This study underscores the need for integrated psychiatric and medical care strategies to improve the long-term outcomes of patients with schizophrenia.
