Cardiovascular disease risk and management in people who experience serious mental illness

Abstract

Background : People with serious mental illness (SMI), particularly schizophrenia, have significantly reduced life expectancy and a mortality rate two to three times higher than the general population. It is estimated that cardiovascular disease (CVD) accounts for 40 to 50 per cent of this excess mortality. However people diagnosed with SMI are not specifically mentioned in New Zealand guidelines for assessing and managing cardiovascular risk. Aims : We reviewed the literature to identify: 1) The relative increase in CVD risk associated with SMI; 2) The recommended assessment and management of CVD and CVD risk in people with SMI. Methods: We reviewed systematic reviews, meta-analyses and relevant single studies published since 2000 or of particular relevance to the New Zealand context. 102 articles passed abstract screening, 42 met the inclusion criteria and were assessed in full for relevance, 34 papers were found to be relevant. Results : - People who experience SMI have a greater relative risk of CVD than the general population after controlling for other risk factors. - This increased risk is present at an earlier age. - Current CVD risk assessment tools may underestimate the risk for this population. - There are inequities in the assessment and management of CVD risk and CVD for people who experience SMI. - People who experience SMI have a significantly higher risk of dying from CVD than their population counterparts. Conclusions : People with SMI have a greater risk of CVD than their counterparts in the general population. The causal pathways are complex. Established risk factors such as smoking and diet do not fully account for this increased risk. Inequities in assessment and management of CVD risk are likely contributors along with the cardio metabolic effects of psychotropic medication. Ensuring guidelines-concordant cardiovascular risk assessment and management is particularly important for this population. It is also necessary to bear in mind that current risk assessment tools are likely to underestimate the risk. The utility of adapting a general population tool to adjust for mental illness, or of creating a specific tool, should be assessed in a New Zealand context.