Serious mental illness tied to elevated CV risk; uncontrolled risk factors prevalent
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Individuals with serious mental illnesses such as bipolar disorder and schizophrenia may experience greater 10- and 30-year CV risk compared with those without a serious mental illness, researchers reported.
According to research published in the Journal of the American Heart Association, elevated 10-year CV risk was observed among patients with a serious mental illness aged 18 to 59 years without CVD at baseline.
Moreover, patients with serious mental illness were more likely to smoke and have BMI of 30 kg/m2 or more compared with patients without a serious mental illness.
“It’s important for cardiac clinicians to keep in mind that we are likely underestimating cardiovascular risk in our patients with serious mental illness when using the American College of Cardiology/American Heart Association and Framingham risk equations,” Rebecca C. Rossom, MD, MS, a senior research investigator in behavioral health at the Center for Chronic Care Innovation at HealthPartners Institute in Minneapolis, told Healio. “Using 30-year risk equations can help us address cardiovascular risk at younger ages, which is important for people with serious mental illness who develop and die of CVD at younger ages than their peers.”
For the present analysis, researchers included 591,257 individuals aged 18 to 75 years with a primary care visit from January 2016 to September 2018, of whom 1.9% had a diagnosed serious mental illness (70.6% with bipolar disorder; 17.6% with schizoaffective disorder; 11.7% with schizophrenia). They utilized atherosclerotic CVD scores to estimate 10-year CV risk for patients aged 40 to 75 years without CVD at baseline and used Framingham risk scores to estimate 30-year CV risk for patients aged 18 to 59 years without baseline CVD.
Individuals with a serious mental illness were generally younger and more likely to be women, identify as Black, Native American/Alaskan Native or of multiple races and have Medicaid or Medicare compared with participants without a serious mental illness.
Elevated CV risk with serious mental illness
Researchers reported that individuals with serious mental illness aged 40 to 75 years had greater mean adjusted 10-year CV risk (9.44%; 95% CI, 9.29-9.6) compared with patients without serious mental illness (7.99%; 95% CI, 7.97-8.02).
Thirty-year estimated CV risk was also greater among those aged 18 to 59 years with serious mental illness, with 25% identified as being in the highest-risk group using Framingham risk scores compared with 11% of those without serious mental illness (P < .001).
Researchers reported that individuals with serious mental illness had greater rates of elevated BMI and smoking. Average BMI was also higher in patients with serious mental illness compared with those without mental illness (mean, 31.1 kg/m2 vs. 28.8 kg/m2).
Individuals with serious mental illness were more likely to have BMI of 30 kg/m2 or more (49.7% vs. 35.6%; P < .0001) and were twice as likely to have BMI of 40 kg/m2 or more.
Smoking was also more prevalent among those with serious mental illness compared with patients without a serious mental illness (36.2% vs. 12.1%).
“The reasons for this are multifactorial,” Rossom told Healio. “The increased stress and catecholamines related to living with a persistent and serious mental illness, often combined with food and housing insecurity and unsafe living environments, predispose people to weight gain and smoking. Additionally, some medications for SMI can impact weight and insulin resistance. Further, research suggests nicotine may lessen disruptions in dopaminergic, glutamatergic and GABAergic pathways for people with schizophrenia.”
CV risk by mental illness diagnosis
After adjustment, researchers observed that individuals aged 40 to 75 years with bipolar disorder had greater 10-year CV risk compared with patients with schizophrenia or schizoaffective disorder; however, patients aged 18 to 59 years with schizoaffective disorder had greater 30-year CV risk compared with those with schizophrenia or bipolar disorder.
“Ideally we should all play a role, as we know that, in our health system and others, as many as 25% of patients with serious mental illness do not see primary care and 25% do not see psychiatry,” Rossom told Healio. “Identifying and addressing CV risk as early as possible in those with serious mental illness, including using 30-year risk equations for those ages 18 to 59, would be a great place to start. In other work, we’ve found that alerting primary care clinicians and patients to their estimated risk and suggesting personalized treatment recommendations resulted in clinically meaningful reductions in modifiable CV risk for people with serious mental illness.
“I primarily want to encourage clinicians to not give up on addressing CV risk for our patients with serious mental illness,” Rossom told Healio. “We can make a meaningful difference in their CV health.”
Reference:
- People with serious mental illness may have increased heart disease risk at younger ages. newsroom.heart.org/news/people-with-serious-mental-illness-may-have-increased-heart-disease-risk-at-younger-ages. Published March 9, 2022. Accessed March 9, 2022.
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