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
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
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
The statement is published in
issue of European Psychiatry and also appears on
the EASD website.
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
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
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
more from the EASD meeting>>