Greater lifetime cardiac risk seen in bipolar disorder, schizophrenia

New studies suggest that primary care patients with serious mental illness are also more likely to experience heart disease.

After adjusting for various factors, individuals aged 40 to 75 years with bipolar disorder, schizophrenia, or schizoaffective disorder are not known to have cardiovascular disease but are compared to those without severe mental illness. The estimated 10-year risk score for atherosclerotic cardiovascular disease was significantly higher (9.44% vs. 7.99%, respectively, according to Rebecca Rossom, MD, MS, and colleagues at the Health Partners Institute in Minneapolis).

Similarly, people aged 18-59 years with any of these serious mental illnesses are more likely to be in the higher cardiovascular risk category for over 30 years compared to those without these mental illnesses. Significantly higher (OR 1.92, 95% 1.82-2.01, P<0.0001), the group reported in Journal of the American Heart Association..

The 30-year risk, also considered a “lifetime” risk, was estimated using the flamingham risk score. In this score, patients were classified into one of five groups based on blood pressure, lipids, diabetic status, and smoking status. Overall, 25% of people with severe mental illness were in the group with the highest lifetime risk, compared to only 11% of people without any of these conditions.

“Previous studies have shown that people diagnosed with a serious mental illness die 10 to 20 years earlier than the average person, and the main cause of death is heart disease,” Rossham said in a statement. explained.

“Our study focuses on the contribution of cardiovascular risk factors such as blood pressure, cholesterol, blood glucose, weight index, and smoking status, and compares the overall risk of cardiovascular disease in people with and without serious mental illness. I did, “she added.

By type of severe mental illness, people with bipolar disorder had the highest risk of 10 years and those with schizoaffective disorder had the highest risk of 30 years.

Two underlying factors appeared to increase cardiovascular risk most in patients with severe mental illness: elevated BMI and smoking status. More specifically, people with severe mental illness were much more likely to have a BMI of 30 or higher (49.7% vs. 35.6%), doubling the proportion of obesity class III (BMI ≥ 40). .. Smoking rates in these patients were also three times higher (36.2% vs. 12.1%).

The analysis included a total of 11,333 patients with severe mental illness (8,004 with bipolar disorder and 3,329 with schizophrenia / schizoaffective disorder) and 579,924 patients without severe mental illness. Was included. All patients were identified through primary care visits from 2016 to 2018. Most individuals were middle-aged and 77% were Caucasian. Diagnosis of serious mental illness was collected from electronic health records.

Rossum’s group pointed out that one of the strengths of this study was the lack of focus on inpatients with these serious mental illnesses. Many other studies tend to be biased towards patients with the most serious illnesses. Instead, they only saw outpatients living in the area.

“Given that people with SMI have a shorter lifespan. [serious mental illness]And a considerable contribution of [cardiovascular] From illness to premature death, the data support more thorough screening and effective management of key cardiovascular risk factors, especially in patients with SMI starting at a young age <40 years. " ..

Rossum also uses 30-year cardiovascular risk estimates in young adults with severe mental illness to introduce risk factor management and prevention early in this high-risk group for cardiovascular morbidity. And recommended that the mortality rate can be reduced.