People with severe mental illness may have an increased risk of heart disease at a younger age

An analysis of nearly 600,000 adults in the United States found that people diagnosed with bipolar disorder, schizophrenia, or schizoaffective disorder may have a higher risk of cardiovascular disease at a younger age compared to adults not diagnosed with one of these serious mental illnesses, according to new research published today in the Journal of the American Heart Associationopen access, peer-reviewed Journal of the American Heart Association.

“Previous research has indicated that people diagnosed with severe mental illness die 10 to 20 years earlier than the general population, and their leading cause of death is heart disease,” said the study’s lead author. , Rebecca C. Rossom, MD, MS, senior behavioral health researcher at the Center for Chronic Care Innovation at the HealthPartners Institute in Minneapolis, Minnesota. “Our study focused on the contribution of cardiovascular risk factors, such as blood pressure, cholesterol, blood sugar, body mass index and smoking status, to comparing the overall risk of heart disease in people affected and without serious mental illness.”

Researchers believe this is the first study to examine estimated 30-year (lifetime) cardiovascular risk in a large sample of adult outpatients diagnosed with bipolar disorder, schizophrenia or schizoaffective disorder – three serious mental illnesses specific to this study. Many previous studies of cardiovascular risk for people with severe mental illness have only included people who are hospitalized, and they tend to have more severe mental illness and poorer health than outpatients, according to Rossom. In contrast, this study included a large sample of non-hospitalized American adults.

According to the National Institute of Mental Health, bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes unusual changes in mood, energy, activity levels, concentration and the ability to perform daily tasks. Tasks. Schizophrenia can cause hallucinations, delusions, or disorganized speech. People with schizophrenia may seem to have lost touch with reality, which can cause significant distress for the person, their family and friends. Symptoms of schizophrenia can be persistent and debilitating. Schizoaffective disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders as an uninterrupted duration of illness during which there is a major mood episode (manic or depressive) in addition to meeting the criteria for schizophrenia.

This analysis assessed health data from nearly 600,000 people, ages 18 to 75, who visited a primary care clinic in Minnesota and Wisconsin between January 2016 and September 2018. Nearly 2%, or about 11 000 adults, have been diagnosed with serious mental illness. Of these, 70% were diagnosed with bipolar disorder, 18% with schizoaffective disorder and 12% with schizophrenia. On average, people with serious mental illness were more likely to be younger; Women; identify as Black, Native American, Alaskan or mixed race; and be insured by Medicaid or Medicare, compared to their counterparts not diagnosed with any of these three serious mental illnesses.

Prediction models providing a standardized metric have been used to assess cardiovascular risk factors and predict the likelihood of heart attack, stroke, or cardiovascular death. To assess 10-year risk, the American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Risk Scoring Tool was used for adults aged 40 to 75 years. The Framingham risk score was used to estimate 30-year cardiovascular risk in adults aged 18-59.

The researchers found:

  • Adults in the study with one of the serious mental illnesses examined had an estimated 10-year cardiovascular risk level of 9.5%, compared to 8% for adults without a mental disorder.
  • The estimated 30-year risk of cardiovascular disease was significantly higher in people with one of three serious mental illnesses – 25% compared with 11% of people without serious mental illness.
  • The increased risk of heart disease was evident even in young adults (ages 18 to 34) with severe mental illness.
  • Across subtypes of each of the three serious mental illnesses in this study, in analyzes adjusted for age, sex, race, ethnicity, and insurance coverage, those with bipolar disorder had the highest 10-year cardiovascular risk compared to people with schizophrenia or schizoaffective disorder. , while people with schizoaffective disorder had the highest cardiovascular risk over 30 years compared to the other two groups.
  • Smoking and body mass index (BMI) accounted for a large proportion of risk factors contributing to cardiovascular disease in people with severe mental illness: people with severe mental illness were three times more likely to being current smokers (36%) than their peers without serious mental illness (12%) and 50% of people with serious mental illness met the criteria for obesity, compared to 36% of people without serious mental illness.
  • People with serious mental illness had twice as many diagnosed diabetes (type 1 or type 2) as people without serious mental illness (14% versus 7%, respectively).
  • 15% of adults with serious mental illness had high blood pressure compared to 13% of those without serious mental illness.

“Even at a younger age, people with severe mental illness had a higher risk of heart disease than their peers, underscoring the importance of addressing cardiovascular risk factors as early as possible for these individuals.” , Rossom said. “Interventions to reduce the risk of heart disease for these individuals are extremely beneficial when initiated at a younger age.

“We encourage health systems and clinicians to use the 30-year cardiovascular risk estimates for young adults with severe mental illness, as they can be used from age 18,” she said. “Right now, 10-year heart disease risk estimates are the most commonly used, and they can’t be applied until people are at least 40, which is too late to start addressing risk. heart disease in people with severe mental illness.”

Co-authors include Stephanie A. Hooker, Ph.D., MPH; Patrick J. O’Connor, MD, MA, MPH; A. Lauren Crain, Ph.D.; and JoAnn M. Sperl-Hillen, MD This work was funded through a cooperative agreement with the National Institute of Mental Health (NIMH), a division of the National Institutes of Health.

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