September 20, 2017
2 min read

Severe mental illness linked to substantially increased risk for CVD

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Christoph U. Correll, MD
Christoph U. Correll

Compared with the general population, those with severe mental illness have a substantially increased risk for CVD, according to findings recently published in World Psychiatry.

Researchers suggested that their findings indicate clinicians should regularly screen patients with severe mental illness for CVD, and proactively manage risk factors for the condition, such as BMI and weight.

“While the existing literature has provided relevant insights, several limitations are to be highlighted and important questions remain unanswered,” Christoph U. Correll, MD, department of psychiatry, Zucker Hillside Hospital, Glen Oaks, New York, and colleagues wrote. “We conducted a large scale meta-analysis investigating the prevalence, incidence and mortality attributed to CVD and their correlates among people with [severe mental illness], both within and across major diagnostic groups.”

Correll and colleagues examined 92 studies involving more than 3.2 million patients with mental disease from the U.S. and 15 other countries and more than 113 million controls from the general population. The mean age of the participants was 50 years.

Researchers found that the pooled CVD prevalence in those with severe mental illness was 9.9% (95% CI, 7.4-13.3). When the data were adjusted for a median of seven confounders, patients had significantly higher odds of CVD vs. controls in cross-sectional studies (OR = 1.53; 95% CI, 1.27-1.83) and higher odds of coronary heart disease (OR = 1.51; 95% CI, 1.47-1.55) and cerebrovascular disease (OR = 1.42; 95% CI, 1.21-1.66). People with major depressive disorder were at increased risk for coronary heart disease, while those with schizophrenia were at increased risk for coronary heart disease, cerebrovascular disease and congestive heart failure. Cumulative CVD incidence in patients with severe mental illness was 3.6% (95% CI, 2.7-5.3) during a median follow-up of 8.4 years (range 1.8-30).

In addition, when the data were adjusted for a median of six confounders, Correll and colleagues noted that patients with severe mental illness had significantly higher CVD incidence than controls in longitudinal studies (HR = 1.78; 95% CI, 1.6-1.98). The incidence was also higher for coronary heart disease (HR = 1.54; 95% CI, 1.3-1.82), cerebrovascular disease (HR = 1.64; 95% CI, 1.26-2.14), congestive heart failure (HR = 2.1; 95% CI, 1.64-2.7), and CVD-related death (HR = 1.85; 95% CI, 1.53-2.24).

Researchers also found that those with major depressive disorder, bipolar disorder and schizophrenia were all at increased risk of CVD-related death vs. controls. CVD incidence increased with antipsychotic use (P = .008), higher BMI (P = .008) and higher baseline CVD prevalence (P = .03) in patients vs. controls. Moreover, CVD prevalence (P = .007), but not CVD incidence (P = .21), increased in some of the more recently conducted studies.

“Based on these results, it is imperative that clinicians: a) only utilize antipsychotics, particularly for nonpsychotic conditions, when alternative treatment options with lower CVD risk potential have been tried sufficiently; and b) screen for and manage emerging and existing CVDs as well as their risk factors, including weight gain and elevated [BMI],” Correll and colleagues wrote. “Our data, adding to research demonstrating a significantly higher prevalence of metabolic syndrome in people with [severe mental illness] compared to controls, clearly suggest there is an urgent need to prevent and manage CVD risk in this population.” – by Janel Miller

Disclosure: Correll reports no relevant financial disclosures. Please see the study for a full list of the other authors’ relevant financial disclosures.