Serious Mental Illness Linked to Elevated Cardiovascular Risk in Analysis of Primary Care Patients

The increased risk of CVD was observed even in young adults with a serious mental illness, according to an analysis of nearly 600 000 US adults.

A new analysis found that primary care patients with serious mental illnesses (SMI), such as bipolar disorder and schizophrenia, experience greater 10- and 30-year cardiovascular (CV) risk compared with those without a serious mental illness.

The study, published in the Journal of the American Heart Association, showed that patients with SMI aged 18 to 59 years without cardiovascular disease (CVD) at baseline faced elevated 10-year CV risk. Also, patients with SMI were more likely to smoke and have a body mass index (BMI) of ≥30 kg/m2 compared to those without SMI.

“Previous research has indicated that people diagnosed with a serious mental illness die 10-20 years earlier than the general population, and their leading cause of death is heart disease,” said lead author, Rebecca C. Rossom, MD, MS, senior investigator, Center for Chronic Care Innovation, HealthPartners Institute, Minneapolis, Minnesota, in an AHA press release. “Our study focused on the contribution of cardiovascular risk factors, such as blood pressure, cholesterol, blood sugar, body mass index and smoking status, to compare overall heart disease risk for people with and without serious mental illness.”

Rossom and colleagues evaluated health data for 591 257 individuals aged 18 to 75 years with a primary care visit from January 2016 to September 2018. Approximately 11 000 participants (1.9%) had a diagnosis of SMI, of whom 70% were diagnosed with bipolar disorder, 18% with schizoaffective disorder, and 12% with schizophrenia.

Researchers used atherosclerotic CVD scores to estimate 10-year CV risk for patients aged 40 to 75 years without CVD at baseline and utilized Framingham risk scores to estimate 30-year CV risk for patients aged 18 to 59 years without CVD at baseline.

Participants with SMI 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 those without SMI, according to the study.

After investigators adjusted for age, sex, race, ethnicity, and insurance type, 10‐year CV risk was significantly higher in patients with SMI (9.44%) compared with those without SMI (7.99%). Similarly, the estimated 30-year CV risk was significantly higher among participants with SMI—25% of patients with SMI in the highest-risk group versus 11% of those without SMI (P<.001).

Within the SMI subtypes, patients with bipolar disorder had the highest 10‐year CV risk, while those with schizoaffective disorder had the highest 30‐year CV risk, researchers reported.

The team noted that one study strength was the fact that they did not focus on inpatients with SMI, as previous studies did and tended to be biased towards patients with the most severe illness. Instead, they only looked at community-dwelling outpatients.

“Given the shortened life span of people with SMI, and the considerable contribution of CV disease to earlier mortality, the data support more thorough screening and effective management of major cardiovascular risk factors for patients with SMI starting at a younger age, especially in those aged <40 years,” concluded authors. “Use of 30‐year cardiovascular risk estimates to help guide decisions about cardiovascular risk factor management and prevention in young adults with SMI may be important to decreasing rates of cardiovascular morbidity and mortality.”