Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis

Abstract

BackgroundCardiovascular risk (CVR) has been observed to be higher in patients with severe mental illness (SMI) than in the general population. However, some studies suggest that CVR is not equally increased in different subgroups of SMI. The purposes of this review are to summarise CVR scores of SMI patients and to determine the differences in CVR between patients with different SMIs and between SMI patients and the control-population.MethodsMEDLINE (via PubMed) was searched for literature published through August 28, 2014, followed by a snowball search in the Web of Science. Observational and experimental studies that reported CVR assessments in SMI patients using validated tools were included. The risk of bias was reported using STROBE and CONSORT criteria. Pooled continuous data were expressed as standardized mean differences (SMD) with 95 % confidence intervals (CI). Two reviewers independently selected studies, extracted data and assessed methodological quality.ResultsA total of 3,608 articles were identified, of which 67 full text papers were assessed for eligibility and 35 were finally included in our review, in which 12,179 psychiatric patients and 225,951 comparative patients had been assessed. The most frequent diagnoses were schizophrenia and related diagnoses (45.7 %), depressive disorders (14.7 %), SMI (11.4 %) and bipolar disorders (8.6 %). The most frequent CVR assessment tool used was the Framingham risk score. Subgroups analysis showed a higher CVR in schizophrenia than in depressive disorder or in studies that included patients with multiple psychiatric diagnoses (SMD: 0.63, 0.03, and 0.02, respectively).Six studies were included in the meta-analysis. Total overall CVR did not differ between SMI patients and controls (SMD: 0.35 [95 % CI:−0.02 to 0.71], p = 0.06); high heterogeneity was observed (I2 = 93 %; p < 0.001).ConclusionsThe summary of results from studies that assessed CVR using validated tools in SMI patients did not find sufficient data (except for limited evidence associated with schizophrenia) to permit any clear conclusions about increased CVR in this group of patients compared to the general population.The systematic review is registered in PROSPERO: CRD42013003898.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0833-6) contains supplementary material, which is available to authorized users.

Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study

“…47 Our study found that 6.8% of women and 4.3% of men had a diagnosis of severe mental illness affects and it was associated with a 14% increased risk of cardiovascular disease for women and a 13% increased risk for men (model B). This is independent of the risk associated with atypical antipsychotics and hence both factors have been included separately as they will have a compound effect on cardiovascular risk.…”

The Physical Health Care Fidelity Scale: Psychometric Properties

“…People with psychosis have increased risk of cardiovascular illness (Foguet-Boreu et al 2016) including in early phases of the illness (Correll et al 2014). But they are less likely than others to receive appropriate health care (Ayerbe et al 2018;De Hert et al 2011;Laursen et al 2014;Mitchell et al 2015).…”

“…Physical disorders account for high morbidity, high mortality and earlier death for persons with psychosis, compared to the general population (Chang et al 2011;Heiberg et al 2018;Hjorthoj et al 2017;Kilbourne et al 2009;Lawrence et al 2013;Nordentoft et al 2013;Osby et al 2016;Saha et al 2007). A major part of this is due to cardiovascular and metabolic disorders including heart disease, hypertension, diabetes, hyperlipidemia and obesity (Correll et al 2014;Foguet-Boreu et al 2016;Stubbs et al 2015;Vancampfort et al 2016). Smoking, unhealthy diet, low physical activity and low medical and dental care contribute to physical illnesses and shorter lives (Correll et al 2017;Kisely et al 2015a, b;Vancampfort et al 2015;Wey et al 2016).…”

Investigating the Agreement Between Cardiovascular Disease Risk Calculators Among People Diagnosed With Schizophrenia

“…The Framingham risk scores (11) apply an algorithm that calculates the predicted CVD risk from risk factors such as diabetes, dyslipidemia, hypertension (23)(24)(25), smoking, and obesity (26,27). This risk calculator is frequently used in the general population but has also been applied to population groups with SMI (28). The prevalence of these risk factors is considerably raised in people with schizophrenia (4, 29-31) and people with schizophrenia have been shown to have higher risk scores than the general population (32)(33)(34).…”