March 09, 2022 3 min read

Serious mental illness tied to elevated CV risk; uncontrolled risk fac

Individuals with serious mental illnesses such as bipolar disorder and schizophrenia may
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

among patients with a serious mental illness aged 18 to 59 years without CVD at baseline.

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Moreover, patients with serious mental illness were more likely to smoke and have BMI of
with patients without a serious mental illness.

“It’s important for cardiac clinicians to keep in mind that we are likely under
 in our patients with serious mental illness when using the American College o
Association and Framingham risk equations,” Rebecca C. Rossom, MD, MS
behavioral health at the Center for Chronic Care Innovation at HealthPartners
Healio. “Using 30-year risk equations can help us address cardiovascular risk
Rebecca C. important for people with serious mental illness who develop and die of CVD
Rossom
peers.”

For the present analysis, researchers included 591,257 individuals aged 18 to 75 years with
January 2016 to September 2018, of whom 1.9% had a diagnosed serious mental illness (70
17.6% with schizoa�ective disorder; 11.7% with schizophrenia). They utilized atherosclero
year CV risk for patients aged 40 to 75 years without CVD at baseline and used Framingham
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 wom
American/Alaskan Native or of multiple races and have Medicaid or Medicare compared w
serious mental illness.

Elevated CV risk with serious mental illness

Researchers reported that individuals with serious mental illness aged 40 to 75 years had g
CV risk (9.44%; 95% CI, 9.29-9.6) compared with patients without serious mental illness

Thirty-year estimated CV risk was also greater among those aged 18 to 59 years with serio
identi�ed as being in the highest-risk group using Framingham risk scores compared with
mental illness (P < .001).

Researchers reported that individuals with serious mental illness had greater rates of elev
BMI was also higher in patients with serious  mental illness compared with those without
kg/m2 vs. 28.8 kg/m2).

Individuals with serious mental illness were more likely to have BMI of 30 kg/m
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
mental illness (36.2% vs. 12.1%).
“The reasons for this are multifactorial,” Rossom told Healio. “The increased stress and c
with a persistent and serious mental illness, often combined with food and housing insecu
environments, predispose people to weight gain and smoking. Additionally, some medicat
and insulin resistance. Further, research suggests nicotine may lessen disruptions in dopa
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 d
risk compared with patients with schizophrenia or schizoa�ective disorder; however, pati
schizoa�ective disorder had greater 30-year CV risk compared with those with schizophre

“Ideally we should all play a role, as we know that, in our health system and others, as ma
serious mental illness do not see primary care and 25% do not see psychiatry,” Rossom to
addressing CV risk as early as possible in those with serious mental illness, including usin
those ages 18 to 59, would be a great place to start. In other work, we’ve found that alertin
patients to their estimated risk and suggesting personalized treatment recommendations
meaningful reductions in modi�able CV risk for people with serious mental illness.

“I primarily want to encourage clinicians to not give up on addressing CV risk for our patie
illness,” Rossom told Healio. “We can make a meaningful di�erence in their CV health.”

Read next
IDEAL

Comprehensive intervention reduces CV risk in adults with mental illness

Reference:
People with serious mental illness may have increased heart disease risk at younger ages.
/people-with-serious-mental-illness-may-have-increased-heart-disease-risk-at-youn
2022. Accessed March 9, 2022.

Read more about

mental illness bipolar disorder schizophrenia schizoaffective disorder obesity
March 28, 2021 2 min read

Severe mental illness increases mortality risk after MI

Patients with a severe mental illness had increased risk for mortality after MI compared w
mental illness, according to results published in BMC Medicine.

“The link between severe mental illness and increased risk of occurrence of many physica
well established. However, less attention has been given to how severe mental illness aects
diseases, including heart attacks,” Caroline Jackson, PhD, chancellor’s fellow at the Unive
U.K., told Healio. “We also wanted to investigate whether any dierences in outcome betwee
mental illness had changed over time, given that it has been about 20 years since the rst st
that such disparities existed and there has been increasing awareness of mental health dis

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