Relative risk of diabetes, dyslipidaemia, hypertension and the metabolic syndrome in people with severe mental illnesses: systematic review and metaanalysis.

David Pj Osborn,Christine A Wright,Michael B King,Gus Levy,Raman Deo,Irwin Nazareth

doi:10.1186/1471-244x-8-84

Abstract

BackgroundSevere mental illnesses (SMI) may be independently associated with cardiovascular risk factors and the metabolic syndrome. We aimed to systematically assess studies that compared diabetes, dyslipidaemia, hypertension and metabolic syndrome in people with and without SMI.MethodsWe systematically searched MEDLINE, EMBASE, CINAHL & PsycINFO. We hand searched reference lists of key articles. We employed three search main themes: SMI, cardiovascular disease, and each cardiovascular risk factor. We selected cross-sectional, case control, cohort or intervention studies comparing one or more risk factor in both SMI and a reference group. We excluded studies without any reference group. We extracted data on: study design, cardiovascular risk factor(s) and their measurement, diagnosis of SMI, study setting, sampling method, nature of comparison group and data on key risk factors.ResultsOf 14592 citations, 134 papers met criteria and 36 were finally included. 26 reported on diabetes, 12 hypertension, 11 dyslipidaemia, and 4 metabolic syndrome. Most studies were cross sectional, small and several lacked comparison data suitable for extraction. Meta-analysis was possible for diabetes, cholesterol and hypertension; revealing a pooled risk ratio of 1.70 (1.21 to 2.37) for diabetes and 1.11 (0.91 to 1.35) of hypertension. Restricting SMI to schizophreniform illnesses yielded a pooled risk ratio for diabetes of 1.87 (1.68 to 2.09). Total cholesterol was not higher in people with SMI (Standardized Mean Difference -0.10 (-0.55 to 0.36)) and there were inconsistent data on HDL, LDL and triglycerides with some, but not all, reporting lower levels of HDL cholesterol and raised triglyceride levels. Metabolic syndrome appeared more common in SMI.ConclusionDiabetes (but not hypertension) is more common in SMI. Data on other risk factors were limited by poor quality or inconsistent research findings, but a small number of studies show greater prevalence of the metabolic syndrome in SMI.

Highlights

Severe mental illnesses (SMI) may be independently associated with cardiovascular risk factors and the metabolic syndrome
People with severe mental illness (SMI) such as schizophrenia and bipolar affective disorder are at greater risk of coronary heart disease (CHD) than people without such diagnoses [1,2,3]
27 papers reported outcomes related to diabetes or hyperglycemia, 14 reported hypertension or blood pressure, 12 dyslipidaemia or lipid levels, 5 the metabolic syndrome and 4 papers included overall cardiovascular risk scores such as a ten year Framingham risk score [48]

Summary

Introduction

Severe mental illnesses (SMI) may be independently associated with cardiovascular risk factors and the metabolic syndrome. We aimed to systematically assess studies that compared diabetes, dyslipidaemia, hypertension and metabolic syndrome in people with and without SMI. People with severe mental illness (SMI) such as schizophrenia and bipolar affective disorder are at greater risk of coronary heart disease (CHD) than people without such diagnoses [1,2,3]. Recent reviews have suggested that people with SMI are at risk of the metabolic syndrome including diabetes irrespective of antipsychotic therapy [7,8]. People with SMI share other risk factors including unhealthy lifestyles [9] obesity and positive family histories [10]

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