Schizophrenia, bipolar increased cardiovascular risk

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What is the link between serious mental health conditions and cardiovascular health? Sergey Filimonov/Stocksy
  • A new study finds that people with serious mental health conditions have an elevated risk of cardiovascular disease throughout adulthood.
  • Cardiovascular disease is the leading cause of death for people with serious mental illness.
  • The long-term risk of heart disease over 30 years more than doubles for people with serious mental illness.

People with serious mental health conditions, such as bipolar disorder, schizophrenia, or schizoaffective disorder, die 10 to 20 years earlier, on average, than individuals without those conditions. The leading cause of death is cardiovascular disease.

A new study assesses their 30-year, adult lifetime risk of cardiovascular disease, plus their 10-year risk.

The research finds that even people aged 18–36 years who have these mental health conditions are at a significantly increased risk of cardiovascular disease.

The lead author of the study is Rebecca C. Rossom, MD, senior behavioral health research investigator at HealthPartners Institute in Minneapolis, MN. She explains:

“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. Interventions to address heart disease risk for these individuals are maximally beneficial when initiated at younger ages.”

“Our study,” says Dr. Rossom, “focused on the contribution of cardiovascular risk factors, such as blood pressure, cholesterol, blood sugar, body mass index [BMI]and smoking status, to compare overall heart disease risk for people with and without serious mental illness.”

The study appears in the Journal of the American Heart Association.

“Right now,” says Dr. Rossom, “estimates of 10-year heart disease risk are used most frequently, and they cannot be applied until people are at least 40 years old, which is too late to start addressing heart disease risk in people with serious mental illness.”

“We encourage healthcare systems and clinicians to use the 30-year cardiovascular risk estimates for young adults with serious mental illness, as these may be used starting at age 18.”

The 30-year cardiovascular risk for people with serious mental health conditions was 25%, more than double the 11% risk for individuals without these conditions.

After adjusting for sex, age, race, ethnicity, and insurer, the researchers found that compared with people without serious mental health conditions:

  • People with schizoaffective disorder had the highest 30-year cardiovascular risk.
  • Those with bipolar disorder had the highest 10-year cardiovascular risk.
  • Of people with serious mental health conditions, 15% had hypertension, compared with 13% of individuals without one of these conditions.

The study also found that people with serious mental health conditions were three times more likely to be smokers than individuals without those conditions. It also found that half were likely to be obese compared with 36% of those without serious mental health conditions.

The study tracked 591,257 individuals. Of the total group, 2%, or 11,333 people, had bipolar disorder, schizophrenia, or schizoaffective disorder.

Seventy percent of those with serious mental health conditions had a diagnosis of bipolar disorder, 18% had schizoaffective disorder, and 12% had schizophrenia.

People with serious mental health conditions were more likely to be female and younger and identify as Black, Native American, Alaskan, or multiracial. They were also more likely to have insurance from Medicare or Medicaid.

Dr. Rossom Told Medical News Today:

“Some of the challenges involved in supporting the overall health of people with [serious mental health conditions] include patients and clinicians not being aware of the increased medical risks that people with [these conditions] carry (including an elevated risk of CV disease).”

Other include challenges “not recognizing how some of our treatments can increase these risks (including some medications used to treat [mental health conditions]which can increase cardiometabolic risk), and not feeling able to meaningfully intervene even when these increased risks are recognized.”

“All of these issues can lead to disparities in health outcomes,” summarized Dr. Rossom.

Therefore, as clinical professor René Ernst Nielsen, of Aalborg University Hospital in Denmark, who was not involved in the study, explained to MNT:

“These patients should perhaps be seen as at special risk, and the level for initiating diagnostic procedures, prophylactic treatment, treatment of risk factors and treatment of existing conditions should perhaps be reduced.”

Prof. Nielsen also pointed out the “risk of diagnostic overshadowing — when the patient is seen by the psychiatrist, the focus is mainly [or] only on the psychiatric symptoms, and physical health is neglected. Similarly, when a patient with a serious mental health condition is seen in the ER, there is an increased risk of interpreting the symptoms as [being] caused by the serious mental health condition.”

“There might be,” added Prof. Nielsen, “a negative attitude toward patients with serious mental health conditions.”

He explained, “They may be perceived as more dangerous, not easy to talk to, and less able to report relevant information, which might be caused by clinicians’ lack of knowledge concerning mental disorders.”

Dr. Rossom is also the lead author of another new study of the possible cardiovascular benefits of clinical support systems optimized for people with serious mental health conditions. she told MNT:

“Our study demonstrates that giving patients with [serious mental health conditions] and clinicians personalized, prioritized summaries of their [cardiovascular] risk status, along with patient-specific suggestions to improve care, resulted in intervention patients having 4% lower [cardiovascular] risk than control patients at 1 year. We were particularly excited to see that the intervention favored patients with [serious mental health conditions] who were in the youngest age group—ages 18–29.”

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