A study of over 600,000 US adults discovered that those diagnosed with bipolar disorder, schizophrenia, or schizoaffective disorder may face a greater risk of cardiovascular disease at a younger age than adults who are not diagnosed with one of those major mental diseases.

This study was “focused on the contribution of cardiovascular risk factors, such as blood pressure, cholesterol, blood sugar, body mass index and smoking status, to compare overall heart disease risk for people with and without serious mental illness,” says study lead author Rebecca C. Rossom.

The researchers believe that this is the first study to assess estimated 30-year (lifetime) cardiovascular risk in a large sample of adult outpatients diagnosed with bipolar disorder, schizophrenia, or schizoaffective disorder – three major mental diseases that are the subject of this investigation. According to Rossom, many earlier studies of cardiovascular risk in people with major mental illness only included hospitalized people, who likely to have more severe mental disease and frailer health than outpatients. This study, on the other hand, comprised a large number of non-hospitalized U.S. people.

Bipolar disorder (previously known as manic-depressive disease or manic depression) is a mental condition that produces extraordinary swings in mood, energy, activity levels, focus, and the capacity to carry out daily duties, according to the National Institute of Mental Health. Hallucinations, delusions, and disorganized speech are all symptoms of schizophrenia. People with schizophrenia may appear to have lost touch with reality, which can be distressing for the person, their family, and friends. Schizophrenia symptoms can be debilitating and chronic. The Diagnostic and Statistical Manual of Mental Disorders defines schizoaffective disorder as an illness with an unbroken course and a major mood episode (manic or depressive) in addition to fitting schizophrenia criteria.

This study looked at health data from over 600,000 persons between the ages of 18 and 75 who visited a primary care clinic in Minnesota or Wisconsin between January 2016 and September 2018. A diagnosis of serious mental illness was found in nearly 2 percent of the population, or about 11,000 adults. 70 percent of them had bipolar disorder, 18 percent had schizoaffective disorder, and 12 percent had schizophrenia. When compared to persons who were not diagnosed with one of the three serious mental disorders, people with serious mental illnesses were more likely to be younger, female, self-identify as Black, Native American, Alaskan, or of several races, and be covered by Medicaid or Medicare.

Prediction models using defined metrics were used to analyze cardiovascular risk variables and estimate the likelihood of a heart attack, stroke, or cardiovascular death. The atherosclerotic cardiovascular risk scoring instrument developed by the American College of Cardiology/American Heart Association was used to assess 10-year risk in persons aged 40 to 75. The Framingham Risk Score was used to calculate cardiovascular risk over the next 30 years in persons aged 18 to 59.

They revealed:

• Adults in the study with one of the serious mental illnesses reviewed had an estimated 10-year cardiovascular risk level of 9.5 percent, compared to 8 percent for adults without a mental condition.
• The estimated 30-year risk of cardiovascular disease was significantly higher among those individuals with one of the three serious mental illnesses – 25 percent compared to 11 percent of people without a serious mental illness.
• The increased risk of heart disease was evident even in young adults (ages 18-34) with a serious mental illness.
• Within the subtypes of each of the three serious mental illnesses in this study, in analyses adjusted for age, sex, race, ethnicity and insurance coverage, people with bipolar disorder had the highest 10-year cardiovascular risk compared to those with schizophrenia or schizoaffective disorder, while people with schizoaffective disorder had the highest 30-year cardiovascular risk when compared to the other two groups.
• Smoking and body mass index (BMI) accounted for much of the risk factors contributing to cardiovascular disease in those with a serious mental illness: those with a serious mental illness were three times more likely to be current smokers (36 percent) compared to peers without serious mental illness (12 percent), and 50 percent of those with a serious mental illness met the criteria for obesity compared to 36 percent of people without a serious mental illness.
• People with a serious mental illness had double the rate of diagnosed diabetes (Type 1 or Type 2) than people without serious mental illness (14 percent vs. 7 percent, respectively).
• 15 percent of adults with a serious mental illness had high blood pressure vs. 13 percent of those without a serious mental illness.

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

Source: 10.1161/JAHA.121.021444

Image Credit: Getty

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