Heart Disease Risk Greater in Patients with Severe Mental Illness

The results of a large study indicate that patients with severe mental illness may have an increased risk of developing heart disease compared with the general population.

The study, published by World Psychiatry, included more than 3.2 million patients from around the world. The authors discovered that patients with severe mental illness, including schizophrenia, bipolar disorder, and major depression, had a 53% increased risk of heart disease compared with healthy patients.

Additionally, the authors discovered that patients with severe mental illness had a 78% increased risk of cardiovascular disease. The risk of mortality from their disease was 85% higher compared with similarly aged healthy patients.

These results highlight the importance of screening patients with severe mental illness for cardiovascular risks and educating these patients on how to modify their risks.

It has been well-established that patients with severe mental illness die 10 to 15 years earlier than the general population, with a high portion of patients dying from heart disease.

The new study is the largest ever meta-analysis of severe mental illness (SMI) and heart disease, and included 92 previously conducted studies. Approximately 10% of patients with severe mental illness had cardiovascular disease at baseline, according to the study.

The authors discovered factors that play a role in increasing the risk of cardiovascular disease include antipsychotic use and high body mass index. These results suggest that, whenever possible, physicians should choose antipsychotics that are less likely to result in weight gain, hypertension, and glucose abnormalities, as these factors can increase the risk of heart disease, according to the study.

“These findings are a stark reminder that people with SMI are being left behind, at a time when the health of the general population as a whole appears to be benefitting from public health initiatives to reduce the burden of cardiovascular disease,” said researcher Brendon Stubbs, PhD. “We found that the prevalence of cardiovascular disease in people with severe mental illness was higher in more recent studies, which suggests that our efforts so far have been unsuccessful in reducing the health gap between people with SMI and the general population.”

The authors also recommend that providers should screen patients with SMI for cardiovascular diseases and manage modifiable risk factors, such as weight. Increasing physical activity and implementing a healthy diet can effectively control weight and improve overall cardiovascular health.

“People with SMI die much earlier than those without these disorders, yet the majority of these premature deaths may be preventable with care that prioritises [sic] lifestyle changes, such as exercise, better nutrition and stopping smoking, along with cautious prescribing of antipsychotics,” Dr Stubbs said.