Severe Mental Illness May Be a Risk Factor for Cardiovascular Disease




Patients with severe mental illness, such as depression, schizophrenia, or bipolar disorder, have an increased risk for cardiovascular disease (CVD) compared with the general population, according to a recent meta-analysis.

The large-scale meta-analysis used data from 92 studies and included a cohort of 3,211,768 patients with a severe mental illness and a cohort of 113,383,368 people without a severe mental illness as controls. Researchers assessed the incidence and prevalence of CVD, coronary heart disease, stroke, transient ischemic attack or cerebrovascular disease, congestive heart failure, peripheral vascular disease, and CVD-related death within these patients.

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Overall, the pooled prevalence of cardiovascular disease was 9.9% in patients with a severe mental illness. Analysis of cross-sectional studies and adjustments for 7 confounders showed that patients with a severe mental illness had significantly higher odds of developing CVD (odds ratio [OR] 1.53), higher odds of developing coronary artery disease (OR 1.51), and higher odds of developing cerebrovascular disease (OR 1.42) compared with controls.

Patients with schizophrenia had an increased risk for coronary heart disease, cerebrovascular disease, and congestive heart failure, and patients with major depressive disorder had an increased risk for coronary heart disease.

During a median of 8.4 years of follow-up, the cumulative incidence of CVD for patients with a severe mental illness was 3.6%. When researchers adjusted for a median of 6 confounders in their analysis of longitudinal studies, they found that patients with severe mental illness had significantly higher incidence of CVD compared with controls, and incidences were higher for coronary heart disease, congestive heart failure, and CVD-related death.

Individuals with major depressive disorder, bipolar disorder, and schizophrenia had an increased risk of CVD-related death compared with controls, and incidence increased with antipsychotic use, higher body mass index, and higher baseline CVD prevalence.

In more recently conducted studies, incidence of CVD did not increase but the prevalence of CVD increased.

“This large-scale meta-analysis confirms that [severe mental illness] patients have significantly increased risk of CVD and CVD-related mortality, and that elevated body mass index, antipsychotic use, and CVD screening and management require urgent clinical attention,” the researchers concluded.1

“These findings are a stark reminder that people with [severe mental illness] are being left behind, at a time when the health of the general population as a whole appears to be benefitting from public health initiatives to reduce the burden of cardiovascular disease.”2

—Melissa Weiss


1. Correll CU, Solmi M, Veronese N, et al. Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls [published online May 12, 2017]. World Psychiatry. doi:10.1002/wps.20420.

2. Severe mental illness linked to much higher risk for cardiovascular disease and associated early death [press release]. London, UK: King’s College London News; May 12, 2017.