A recent study published in the Journal of the American Heart Association has shown that patients with bipolar disorder and schizophrenia are at a significant risk of cardiovascular disease compared to those who did not have these mental illnesses.¹

For the study, researchers enrolled 579,924 patients aged 18 to 75 years without serious mental illness and 11,333 patients who had been diagnosed with a serious mental illness between January 2016 and September 2018. Women constituted the majority (~60%) among those with serious mental illness and also in the group without serious mental illness (54%).  

The most common serious mental illness in the study group was bipolar disorder in nearly 71% of patients followed by schizoaffective disorder in 17.6% and schizophrenia in 11.7%. Compared to individuals without any mental illness, they were more likely to be "younger, female, self-identify as Black race, Native American, Alaskan race or of multiple races and be insured by Medicaid or Medicare".

The 10-year cardiovascular risk among adults aged 40-75 years old who did not have heart disease was estimated using American College of Cardiology/American Heart Association (ACC/AHA) atherosclerotic cardiovascular risk scoring tool, while the Framingham Risk Score was used to calculate the 30-year cardiovascular risk among adults aged 18-59 years old without cardiovascular disease.

The 10-year cardiovascular risk was estimated to be 9.5% in patients with bipolar disorder, schizoaffective disorder or schizophrenia compared to nearly 8% in individuals without any serious mental illness after adjusting for other variables such as age, race, sex, ethnicity and insurance type. When the 30-year risk of cardiovascular disease was calculated for those aged 18 to 59 years without known CVD, it was found to be significantly higher among those with any one of the mental illnesses examined in this study; 25% vs 11%, respectively. Notably, this risk was seen even in young individuals aged 18 to 34 years.

When risks were assessed individually for the three mental disorders, people with bipolar disorder were found to have the highest 10-year cardiovascular risk than those with schizophrenia or schizoaffective disorder, while individuals with schizoaffective disorder had the highest 30-year cardiovascular risk vs those with schizophrenia and bipolar disorder.

Analysis also showed that patients with mental illness were twice more likely to be diabetic (14% vs 7%). Fifteen percent of patients with serious mental illness were hypertensive compared to 13% of those without the mental illness. The prevalence of current smoking was higher among patients with serious mental illness; 36% vs 12%, respectively. About 80% of patients with serious mental illness had a body mass index (BMI) of >24.9 vs 69% of patients without mental illness. Half of those with mental illness were obese with BMI ≥30 vs 36% without the mental illness. However, the study does not mention the impact of anti-psychotic drugs and menopausal hormone changes on the mental status of the population studied.

This study highlights that patients with serious mental illness are at a higher risk of cardiovascular disease. Raised BMI and smoking were the risk factors most commonly implicated in the increased cardiovascular risk. Hence, they, particularly the young patients, should be evaluated for cardiovascular risk, which must be tackled in a timely manner to reduce the associated morbidity and mortality. This requires a multidisciplinary team approach.

Reference

1. Rossom RC, et al. Cardiovascular risk for patients with and without schizophrenia, schizoaffective disorder, or bipolar disorder. J Am Heart Assoc. 2022 Mar 9;e021444. doi: 10.1161/JAHA.121.021444.