Jian-Feng Long, Li-Min Deng, Jian-Dong Zhang, Zhen-Jie Tang, Kang Zhou
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.