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Psychosis, bipolar disorder may lead to worse CVD outcomes in military veterans
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Among military veterans, psychosis and bipolar disorder were more strongly linked to CVD events, such as MI and stroke and CVD mortality compared with other psychiatric diagnoses.
According to the study published in Circulation: Cardiovascular Quality and Outcomes, among diagnoses including psychosis, bipolar disorder, depression, anxiety and PTSD in male veterans, psychosis had the largest effect on CVD events and CVD mortality (adjusted OR for CVD events = 1.18; 95% CI, 1.14-1.23; aOR for CVD mortality = 1.48; 95% CI, 1.41-1.56). Among female veterans, bipolar disorder was also predictive of CVD events and mortality (aOR for CVD events = 1.3; 95% CI, 1.11-1.51; aOR for CVD mortality = 1.42; 95% CI, 1.13-1.79), but psychosis remained the biggest indicator (aOR for CVD events = 1.41; 95% CI, 1.17-1.7; aOR for CVD mortality = 1.97; 95% CI, 1.52-2.57).
In addition, researchers observed that PTSD was associated with a small but statistically significant protective effect against CVD events and CVD mortality (aOR for CVD events = 0.88; 95% CI, 0.86-0.9; aOR for CVD mortality = 0.86; 95% CI, 0.83-0.89).
“This study underscores the importance of working across disciplines and medical specialties to provide the best possible care for patients,” Mary C. Vance, MD, MSc, of the Henry M. Jackson Foundation for the Advancement of Military Medicine and assistant professor of psychiatry at the Uniformed Services University School of Medicine, told Healio. “For example, cardiologists could keep in mind that a patient’s mental illness has implications for their cardiovascular outcomes and modify treatment accordingly. And psychiatrists could keep in mind that, because a patient with schizophrenia is actually more likely to die of CVD, the patient should be encouraged to take their statin as well as their antipsychotic.”
In other findings, male veterans with anxiety showed a higher risk for CVD mortality (aOR in men = 1.03; 95% CI, 1-1.07; aOR in women = 0.9; 95% CI, 0.76-1.08).
“What is somewhat surprising, however, is that mental illnesses were more strongly associated with CVD death than CVD events. The reason could be that individuals with mental illness are more likely to have delayed presentations or delays in care for CVD than individuals without mental illness, resulting in more fatal occurrences of CVD,” Vance said. “Another surprise is that individuals with PTSD were found to be at slightly but significantly lower risk of CVD events and death. This finding contrasts with some of the other studies that are out there, and we need further studies to understand what's happening.”
Moreover, depression was more strongly associated with CVD events in female veterans (aOR in women = 1.13; 95% CI, 1.02-1.26; aOR in men = 1.11; 95% CI, 1.08-1.13).
“One possibility for why some findings were significant in men but not in women is that the sample size may not have been large enough to detect a small difference for women,” Vance said. “However, there are other studies with smaller sample sizes that did find significant associations for women, so that is probably not the entire explanation. Notably, effect sizes for psychosis and bipolar disorder were stronger for women than for men, and the reasons why are not clear.”
To analyze the association between psychiatric diagnosis and CVD events and CVD mortality from baseline (2005 to 2009) to 5 years after (2010 to 2014), researchers used a national primary prevention cohort of military veterans receiving care in the Department of Veterans Affairs. Individuals included in the cohort (1.5 million men; 94,191 women; mean age, 61.6 years; 68% white; 61.2% with antihypertensive prescription) were stratified by sex and adjusted for psychiatric diagnoses, age, race, conventional CVD risk factors and antipsychotic and anticonvulsant medication prescriptions.
“Additionally, our study’s findings have implications for the calculation of CVD risk: Because current evidence suggests that overall CVD risk is the most important factor in determining absolute benefit from statins and blood pressure treatment, the inclusion of psychiatric diagnoses in automated CVD risk calculators has the potential to avoid undertreatment of those with serious mental illness,” Vance and colleagues wrote. “As our assessment is nationally representative of VA users, the data herein are ideal for use in calibrating CVD risk scores specific to this population — an initiative currently being explored by the VA.”
Vance told Healio, “One idea for a future study would be to insert the presence of a mental illness diagnosis into automated CVD risk calculators, which may improve the accuracy of the calculations and more appropriately target individuals with serious mental illnesses for statin and blood pressure treatment.” – by Scott Buzby
Disclosures: Vance reports no relevant financial disclosures. The other authors report no relevant financial disclosures.
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