Prediction of cardiovascular disease risk among people with severe mental illness: A cohort study.

Ruth Cunningham,Ian Soosay,Katrina Poppe,Debbie Peterson,Susanna Every-Palmer,Rod Jackson,Kenji Hashimoto

doi:10.1371/journal.pone.0221521

Ruth Cunningham, Ian Soosay + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0221521

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Journal: PloS one	Publication Date: Sep 18, 2019
Citations: 45	License type: CC BY 4.0

Affiliation: University of Otago, University of Auckland

Abstract

To determine whether contemporary sex-specific cardiovascular disease (CVD) risk prediction equations underestimate CVD risk in people with severe mental illness from the cohort in which the equations were derived. We identified people with severe mental illness using information on prior specialist mental health treatment. This group were identified from the PREDICT study, a prospective cohort study of 495,388 primary care patients aged 30 to 74 years without prior CVD that was recently used to derive new CVD risk prediction equations. CVD risk was calculated in participants with and without severe mental illness using the new equations and the predicted CVD risk was compared with observed risk in the two participant groups using survival methods. 28,734 people with a history of recent contact with specialist mental health services, including those without a diagnosis of a psychotic disorder, were identified in the PREDICT cohort. They had a higher observed rate of CVD events compared to those without such a history. The PREDICT equations underestimated the risk for this group, with a mean observed:predicted risk ratio of 1.29 in men and 1.64 in women. In contrast the PREDICT algorithm performed well for those without mental illness. Clinicians using CVD risk assessment tools that do not include severe mental illness as a predictor could by underestimating CVD risk by about one-third in men and two-thirds in women in this patient group. All CVD risk prediction equations should be updated to include mental illness indicators.

Highlights

Experience of severe mental illness (SMI) is associated with higher prevalence, incidence and mortality from a range of cardiovascular diseases (CVD) including coronary heart disease, congestive heart failure and cerebrovascular disease.[1]
SMI can be defined narrowly to include people with diagnoses of functional psychosis including schizophrenia and bipolar disorder, or more broadly to include major depression and/or anxiety, or using a definition which relates to the level of need for services or functional disturbance, with evidence of increased CVD risk in all groups.[1,2,3,4]
Demonstrating the magnitude of this underestimation of CVD risk is important for primary care practice, as mental illness is not included most available risk prediction algorithms

Summary

Introduction

Experience of severe mental illness (SMI) is associated with higher prevalence, incidence and mortality from a range of cardiovascular diseases (CVD) including coronary heart disease, congestive heart failure and cerebrovascular disease.[1]. This increased risk of CVD is an important factor in the high rates of premature mortality among people with SMI.[1,2] SMI can be defined narrowly to include people with diagnoses of functional psychosis including schizophrenia and bipolar disorder, or more broadly to include major depression and/or anxiety, or using a definition which relates to the level of need for services or functional disturbance, with evidence of increased CVD risk in all groups.[1,2,3,4]

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