Abstract
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Patients with severe mental illness (SMI) are at a higher risk for developing CVD and have a higher risk for harboring factors related to CVD. In addition to the effects of antipsychotic medications, unhealthy lifestyle factors, such as poor diet, inadequate physical activity, cigarette smoking, and sedentary behaviors, are known to be risk factors that may contribute to poor cardiovascular health in patients with SMI. Early identification of individuals at elevated risk of CVD is essential so that dietary and lifestyle modifications or pharmacological interventions can be prescribed to alleviate the risk of cardiovascular disease. The objective of the study was to determine the 10-year risk of cardiovascular disease among patients with severe mental illness at Mbarara Regional Referral Hospital, southwestern Uganda. We conducted a cross-sectional study at the outpatient mental health clinic of Mbarara Regional Referral Hospital, between October 2018 and March 2019. We used the Globorisk CVD risk score to estimate the 10-year risk of CVD among patients with SMI, using the online Globorisk calculator. Participants were then assigned to one of three categories depending on their 10-year CVD risk score: <3% (low), 3–10% (intermediate), and >10% (high). We calculated the risk scores of 125 participants aged 40-74 years. Most of the participants were female 75 (60%), had a diagnosis of bipolar disorder 75 (60%), and had mental illness for ≥10 years 57 (46%). Eighty five percent (85%) of the participants had intermediate to high 10-year risk of CVD (64% with intermediate and 21% with high risk). The average risk score was significantly higher in males compared to females, 8.82% versus 6.43%, p = 0.016. We detected a high 10-year risk of CVD in a significant proportion of patients with SMI in southwestern Uganda. We recommend lifestyle modifications and pharmacological interventions to reverse risk or delay progression to CVD in this patient population.
Highlights
Cardiovascular disease (CVD), which includes ischaemic heart disease and stroke, is a leading cause of morbidity and mortality worldwide [1]
We used a novel risk score, the Globorisk score [21], a score that has been validated for use in low resource settings including Uganda, to determine the 10-year risk of CVD among patients with severe mental illness (SMI) at Mbarara Regional Referral Hospital (MRRH), southwestern Uganda
Our results indicate that patients with SMI at Mbarara Regional Referral Hospital are at an increased 10-year risk of CVD, with 80.84% having intermediate to high risk, the risk being higher in males compared to females
Summary
Cardiovascular disease (CVD), which includes ischaemic heart disease and stroke, is a leading cause of morbidity and mortality worldwide [1]. Current recommendations on the prevention of CVD in clinical practice emphasize the need to base interventions on an assessment of the individual’s total burden of risk rather than on the level of any particular risk factor [14, 15]. This is because most people who develop CVD have several risk factors which interact to produce their total risk. We used a novel risk score, the Globorisk score [21], a score that has been validated for use in low resource settings including Uganda, to determine the 10-year risk of CVD among patients with SMI at Mbarara Regional Referral Hospital (MRRH), southwestern Uganda
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