Managing cardiovascular disease risk in patients with severe mental illness

Constanza Caneo

doi:10.1016/s2215-0366(18)30005-1

Abstract

Managing cardiovascular disease risk in patients with severe mental illness

Highlights

LMH was the chair of the NICE guideline development group for CG192 (Antenatal and Postnatal Mental Health) and has collaborated with some of the authors of the paper linked to this Comment, including co-editing The Lancet Perinatal Mental Health Series with Alan Stein
Evidence to support treatment with statins for dyslipidaemia, metformin for weight loss, and bupropion for smoking cessation is good;[3] evidence is scarce regarding multi-risk factor approaches for cardiovascular disease management in populations with severe mental illnesses that resemble real-life clinical practice
In The Lancet Psychiatry, David Osborn and colleagues[4] report on the Primrose intervention, a new patientcentred care model for cardiovascular disease management in a population with severe mental illnesses, which involved a multi-risk factor, individualised intervention based on Behaviour Change Wheel theory.[5]

Summary

Introduction

Evidence to support treatment with statins for dyslipidaemia, metformin for weight loss, and bupropion for smoking cessation is good;[3] evidence is scarce regarding multi-risk factor approaches for cardiovascular disease management in populations with severe mental illnesses that resemble real-life clinical practice. In The Lancet Psychiatry, David Osborn and colleagues[4] report on the Primrose intervention, a new patientcentred care model for cardiovascular disease management in a population with severe mental illnesses, which involved a multi-risk factor, individualised intervention based on Behaviour Change Wheel theory.[5] Patients discussed, and with practice nurses or healthcare assistants agreed, goals to lower cardiovascular disease risk, such as adhering to statins, improving diet or physical activity levels, reducing alcohol, or quitting smoking.[4] In Osborn and colleagues’ cluster randomised trial,[4] done in 76 rural and urban general practices in England with 327 patients, the primary outcome, total cholesterol concentration, decreased in both treatment groups at 12 months (–0·22 mmol/L [SD 1·1] for Primrose vs –0·36 mmol/L [1·1] for treatment as usual).

Results

Conclusion