Statement emphasizes link between severe mental illness, CVD, diabetes

European organizations are calling for improved care and screening for CVD, diabetes in those with mental illnesses.

45th Annual Meeting of the European Association for the Study of Diabetes

People with severe mental illnesses, such as schizophrenia, depression and bipolar disorder, die about 10 to 20 years prematurely compared with the general population, and the most common cause of death is cardiovascular disease, experts said at a press conference on Wednesday.

A joint statement issued by the European Association for the Study of Diabetes, European Society of Cardiology and European Psychiatric Association emphasizes the link between mental illness and CVD, with the goal of increasing awareness, improving care and initiating cooperation and screening.

“In addition to having the devastating effects of severe mental illness, people with schizophrenia and bipolar disorder die prematurely,” Richard Holt, MD, PhD, from the University of Southampton, United Kingdom, said during a press conference.

People with mental illness find it much harder to access physical health services, Holt noted. “Rates of screening for both diabetes and CVD are significantly less than in the general population,” he said. “While maybe 20% of cases of diabetes are unknown in the general population, among people with mental illness, as many as 70% are undiagnosed.”

The statement is published in the September issue of European Psychiatry and also appears on the EASD website.

Increased risk, opportunities for screening

Although suicide and trauma are well-recognized causes of mortality in this population, physical illnesses account for about three-quarters of all deaths, including CVD, according to Holt. Further, diabetes is two to three times more common among people with severe mental illness, and this may account for some of the excess risk of CVD, he said.

Much of the risk among people with severe mental illness can be attributed to lifestyle factors, according to Holt. The excess CV mortality can be attributed to modifiable coronary heart disease risk factors, including obesity, smoking, diabetes, hypertension and dyslipidemia.

Many people with severe mental illness have developed diabetes and CVD without recognition and without appropriate treatment due to a “lack of attention, lack of identification and lack of awareness,” added Ulf Smith, MD, PhD, president of the EASD.

The statement documents the relationship between mental illness, CVD and diabetes, and provides guidance for screening. This includes: details of any history of previous CVD, diabetes or other related disease; family history of premature CVD, diabetes or other related disease; smoking; clinical examination; measurement of weight and height in order to calculate BMI and waist circumference; blood testing to include fasting blood glucose, fasting blood lipids, total cholesterol, triglycerides, LDL and HDL; and electrocardiography.

Further, not only are diabetes and CVD more common in this population, but they may occur at a much younger age, according to Holt. “We need to start to screen for diabetes and CV risk factors from a much earlier age from the time of diagnosis,” he said.

In addition, antipsychotic medications and antidepressants may induce weight gain or worsen metabolic CV risk factors. However, antipsychotic drugs are an effective and necessary component of the management of schizophrenia and bipolar illness, Holt in a press release.

Overall, the statement encourages cooperation and shared care between the different health care professionals involved in caring for patients with severe mental illness. – by Katie Kalvaitis

De Hert M. Eur Psychiatry. 2009;24:412-424.

Although it is true that patients with severe mental illness have an excess of CV risk, the result in part of lifestyle-related behaviors and the extent to which these are modifiable is unclear. On the other hand, there are a number of prevention-oriented therapeutic interventions which may be helpful. Unfortunately, compliance and persistence on medications may also limit the effectiveness of such strategies as well. Both issues together may prove insurmountable for those with severe mental illness, particularly if their primary medical interventions are also associated with the creation or worsening of this excess CHD risk.

– Alan J. Garber, MD, PhD

Endocrine Today Chief Medical Editor