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Serious mental illness tied to increased CV risk, starting in young adulthood

Journal of the American Heart Association
Reuters Health - 16/03/2022 - Bipolar disorder, schizophrenia and schizoaffective disorder are all associated with an increased risk of cardiovascular (CV) disease at younger ages, a medical records analysis suggests.

"While we expected, based on previous literature, that people with serious mental illness (SMI) would have increased CV risk, we were surprised to see even the 30-year risk estimates, which are used for people ages 18-59 without heart disease, were significantly elevated for in people with SMI compared to people without," Dr. Rebecca Rossom of HealthPartners Institute in Minneapolis told Reuters Health by email. "This finding emphasized the importance of treating CV risk at young ages for those with SMI."

"Waiting until age 40 to screen for CV risk, which is when the more commonly used 10-year risk equations are used, is simply too late," she said. "People with SMI die 10-20 years earlier than their peers, and their leading cause of death is CV disease. We need to be screening and intervening at young ages."

As reported in the Journal of the American Heart Association, Dr. Rossom and colleagues compared the estimated 10-year and 30-year CV risk in primary care patients with and without one of three SMIs: bipolar disorder, schizophrenia, or schizoaffective disorder.

The 10-year CV risk was estimated using atherosclerotic CV disease scores for patients ages 40 to 75 years without CV disease; the 30-year CV risk, as Dr. Rossom indicated, was estimated using Framingham risk scores for patients ages 18 to 59 years without CV disease.

Models were adjusted for age, sex, race, ethnicity, and insurance type.

A total of 579, 924 patients without SMI and 11,333 with SMI were included in the analysis. Overall, the mean age was about 45; about 56% were women; and 78% were white.

Among those with SMI, 70% had bipolar disorder; 18% had schizoaffective disorder; and 12% had schizophrenia.

After adjustment, the 10-year CV risk was significantly higher in patients with SMI (mean, 9.44%) compared to those without (mean, 7.99%).

Similarly, the 30-year CV risk was significantly higher in those with SMI (25% of patients with SMI in the highest-risk group compared with 11% of patients without SMI).

The individual CV risk factors contributing most to increased risk for those with SMI were elevated body mass index and smoking: those with SMI were three times more likely to be current smokers (36%) compared to those without (12%), and 50% of those with SMI met the criteria for obesity compared to 36% of those without.

Further, individuals with SMI had double the rate of diagnosed diabetes (14% vs. 7%), and 15% had hypertension compared with 13% of those without SMI.

Among SMI subtypes, patients with bipolar disorder had the highest 10-year CV risk, while those with schizoaffective disorder had the highest 30-year CV risk.

Dr. Richard Kovach, Chair, Interventional Cardiology at Deborah Heart and Lung Center in Brown Mills, New Jersey, commented on the study in an email to Reuters Health. "The authors conclude that there was significantly increased CV risk associated with SMI even in young adults, and that addressing these risk factors should occur at as young an age as possible."

"This increased risk was primarily due to an increased incidence of morbid obesity, smoking and diabetes... in patients with SMI as opposed to no SMI," he said. "If any young patient presents with increased CV risk factors, would you not treat them at as early an age as possible, whether or not they have a SMI?"

The study raised several additional questions for Dr. Kovach, including: Is the increase in CV risk factors in young patients with SMI directly caused by the SMI, or more likely the result of an increased incidence of unhealthy behaviors associated with SMI, such as overeating and smoking at a younger age? Was there any difference in the overall frequency of outpatient visits between those with and without SMI that might have influenced the management of CV risk factors? If CV risk factors were addressed, was there a difference in compliance with treatment between the two groups?

"I would submit that all young patients presenting for regular follow-up with their primary care physicians should have a thorough history and physical along with appropriate screening and management when indicated, regardless of the presence of SMI," Dr. Kovach said. "Bad eating habits and adverse behaviors are not exclusive to patients with SMI."

SOURCE: https://bit.ly/3JjHjlq Journal of the American Heart Association, online March 9, 2022.

By Marilynn Larkin

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