Study data published in the Journal of the American Heart Association outline a significantly increased risk for cardiovascular disease in patients with serious mental illness (SMI), including schizophrenia, schizoaffective disorder, and bipolar disorder. In a large multicenter study of patients with and without SMI, the 10- and 30-year risk estimates for cardiovascular disease (CVD) were substantially elevated in the SMI group.
This cross-sectional study enrolled adult patients with a primary care visit between January 2016 and September 2018 at participating health care centers in Minnesota and Wisconsin. Patients in the SMI group had ≥2 outpatient diagnostic codes or ≥1 inpatient code for SMI in the electronic health record.
For patients aged 40 to 75 years without CVD, the 10-year cardiovascular risk was estimated using the atherosclerotic cardiovascular disease (ASCVD) risk score. The ASCVD assigns a score from 0 to 100 to estimate a patient’s risk for myocardial infarction, stroke, or cardiovascular death within the next 10 years.
For patients aged 18 to 59 years without CVD, the 30-year risk was calculated using the Framingham risk score and stratified into 5 categories per factors. General linear and logistic regression models were used to estimate the impact of SMI on 10- and 30-year CVD risk scores. Models were adjusted for age, sex, race/ethnicity, and insurance type.
The final sample comprised 591,257 patients, among whom 11,333 had SMI. The distribution of diagnoses was as follows: 8,004 (70.65) with bipolar disorder; 2,000 (17.6%) with the schizoaffective disorder; and 1,329 (11.7%) with schizophrenia. In adjusted models, the 10-year ASCVD risk was 8.31 among patients with SMI (95% CI, 8.15-8.46), compared to 7.92 (95% CI, 7.90-7.95) among patients without SMI (P <.0001).
The 30-year cardiovascular risk was significantly higher with SMI in both unadjusted and adjusted estimates; a greater proportion of patients with SMI had ≥1 major uncontrolled cardiovascular risk factor compared to patients without SMI. Specifically, a greater number of patients with SMI were diagnosed with CVD (4.6% vs 3.7%; P <.0001), coronary heart disease (3.0% vs 2.6%; P =.015), or hypertension (14.9% vs 13.2%; P <.0001) at baseline. The specific factors contributing most to elevated CVD risk in patients with SMI were body mass index and smoking.
Within the SMI group, patients with schizophrenia had the highest unadjusted 10-year cardiovascular risk. However, after adjusting for demographic characteristics, patients aged 40 to 75 years with bipolar disorder had a greater 10-year risk than patients with schizophrenia or schizoaffective disorder. The greatest adjusted 30-year risk was observed in patients aged 18 to 59 years with schizoaffective disorder.
Data from this study indicate that SMI confers an increased risk for cardiovascular disease, even after accounting for demographic covariates. Limitations of this study include its conduct within an integrated health care system, which may prevent generalizability to other settings. Further, certain lifestyle factors were not captured, including medication use, income, and educational attainment.
“Given the shortened life span of people with SMI, and the considerable contribution of CV disease to earlier mortality, the data support more thorough screening and effective management of major cardiovascular risk factors for patients with SMI starting at a younger age, especially in those aged <40 years,” investigators wrote.
“Use of 30-year cardiovascular risk estimates to help guide decisions about cardiovascular risk factor management and prevention in young adults with SMI may be important to decreasing rates of cardiovascular morbidity and mortality.”
Rossom RC, Hooker SA, O’Connor PJ, Crain AL, Sperl-Hillen JM. Cardiovascular risk for patients with and without schizophrenia, schizoaffective disorder, or bipolar disorder. J Am Heart Assoc. Published online March 9, 2022. doi:10.1161/JAHA.121.021444