Serious Mental Illness May Increase Risk of Heart Disease at Younger Ages

Individuals with bipolar or schizoaffective disorder or schizophrenia may have a higher risk of cardiovascular disease (CVD) at younger ages those who have not been diagnosed with 1 of those serious mental illnesses, according to the results of an analysis published in the Journal of the American Heart Association.

“Previous research has indicated that people diagnosed with a serious mental illness die 10 to 20 years earlier than the general population, and their leading cause of death is heart disease,” Rebecca Rossom, MD, MS, a senior research investigator in behavioral health at the Center for Chronic Care Innovation at HealthPartners Institute in Minneapolis, Minnesota, said in a statement. “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.”.

This is 1 of the first studies to examine estimated 30-year cardiovascular risk in a large sample of outpatients diagnosed with 1 of the 3 serious mental illnesses specific to the study, investigators said.

The results of previous studies looking at cardiovascular risk for individuals with serious mental illness have only included those who were hospitalized, and these patients tend to be in frailer health and have more severe mental illness than outpatients, Rossom said.

The analysis included about 600,000 adults in the United States, aged 18 to 75 years, who visited primary-care clinics in Minnesota or Wisconsin between January 2019 and September 2018.

Approximately 11,000 individuals had a diagnosis of serious mental illness, 70% with bipolar disorder, 18% with schizoaffective disorder, and 12% with schizophrenia.

Prediction models that provided a standardized metric were used to assess for cardiovascular risk factors and predict the likelihood of CVD, heart attack, or stroke. To assess the 10-year risk, the American College of CardiologyAmerican Heart Association’s atherosclerotic cardiovascular risk scoring tool was used among those aged 40 to 75 years.

Additionally, the Framingham Risk Score was used to calculate the 30-year risk among those aged 18 to 59 years.

Investigators found that individuals in the study with 1 of the serious mental illnesses reviewed had an estimated 10-year cardiovascular level of 9.5% compared with 8% for adults without a mental condition.

Additionally, the estimated 30-year risk of CVD was significantly higher among those with 1 of the 3 serious mental illnesses at 25% compared with 11% of those without.

The increased risk of heart disease was even among adults aged 18 to 34 years with a serious mental illness.

Within the subtype of each of the 3 serious mental illnesses studied, investigators adjusted for age, ethnicity, insurance coverage, race, and sex and found that individuals with bipolar disorder had the highest 10-year cardiovascular risk compared with the other illnesses, and individuals with schizoaffective disorder had the highest 30-year cardiovascular risk.

Meanwhile, body mass index and smoking accounted for many of the risk factors that contributed to CVD in those with a serious mental illness. Those with a serious mental illness were 3 times more likely to smoke and about half of them met the criteria for obesity compared with 12% and 36% of individuals without a serious mental illness, respectively.

Individuals with a serious mental illness also had double the rate of being diagnosed with diabetes than individuals without mental illness, and about 15% of individuals with a serious mental illness had high blood pressure compared with 13% without.

“Even at younger ages, people with serious mental illness had a higher risk of heart disease than their peers, which highlights the importance of addressing cardiovascular risk factors for these individuals as early as possible,” Rossom said. “Interventions to address heart disease risk for these individuals are maximally beneficial when initiated at younger ages.

Reference

People with serious mental illness may have increased heart disease risk at younger ages. EurekAlert. News release. March 9, 2022. Accessed March 22, 2022. https://www.eurekalert.org/news-releases/945403