Editorial: Mentally ill patients at risk for cardiovascular disease

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People with mental illnesses such as schizophrenia, bipolar disorder and major depression, lose 25 to 30 years of life expectancy compared to the general population, and most of those premature deaths are due to cardiovascular disease, according to a commentary article in Oct. 17 issue of in the Journal of the American Medical Association.

“Not only are these patients dealing with the serious burden that accompanies their psychiatric disorder, but they also have an increased risk and an increased burden from major medical conditions like diabetes, heart disease and stroke. Ultimately, it is the unrecognized risk factors and the under-diagnosed and under-treated conditions that significantly shorten the lifespan,” said John Newcomer, MD, author and professor of psychiatry, of psychology and of medicine and medical director of the Center for Clinical Studies at Washington University.

Newcomer commented that several factors combine to elevate the risks. Major mental disorders significantly impair a person's ability to work and learn, so patients tend to have lower incomes and poorer dietary habits, often relying instead on fast food.

Additionally, patients with psychiatric illnesses are much more likely to smoke, and although the severely mentally ill make up only between 5 percent and 10 percent of the population, between 50 and 80 percent smoke. Many psychiatric medications also tend to contribute to weight gain, by making people less active and sometimes by stimulating appetite. Weight gain can be a prominent side effect of some antipsychotic drugs.

Newcomer also reported that patients with mental illness are significantly less likely to receive therapies of proven benefit for problems with cholesterol, diabetes, hypertension or heart disease. Those who have survived a heart attack are less likely to receive appropriate medications, cardiac catheterization procedures or bypass surgery than heart-attack patients without mental illness.

Newcomer cited data from a National Institute of Mental Health-funded study of 1,500 patients with chronic schizophrenia. The study found that 88 percent of patients entering the study with high cholesterol did not take lipid-lowering drugs. Another 30 percent with diabetes were not receiving anti-diabetes medications, and 62 percent of those with high blood pressure were not taking antihypertensive medication.

A solution, Newcomer argued, will emerge only if psychiatrists and primary-care providers work together.

“Coordination between psychiatric professionals and primary-care providers is not easy when they often are physically located in different places. There are transportation issues and scheduling issues. For healthy people, the need to make an extra appointment lowers the probability that it will actually happen,” according to Newcomer.

Newcomer said that to lower risk of cardiovascular complications, psychiatrists may need to regularly weigh their patients, take blood pressure and screen appropriately for blood glucose, cholesterol and triglycerides.

“Most of these patients already are seeing a physician, and if that physician and medical team can screen for cardiovascular risk factors, we may be able to intervene and find ways to lower that risk significantly,” concluded Newcomer.