Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2016

Open Access 01-12-2016 | Research article

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

Authors: Quintí Foguet-Boreu, Maria Isabel Fernandez San Martin, Gemma Flores Mateo, Edurne Zabaleta del Olmo, Luís Ayerbe García-Morzon, Maria Perez-Piñar López, Luis Miguel Martin-López, Javier Montes Hidalgo, Concepción Violán

Published in: BMC Psychiatry | Issue 1/2016

Login to get access

Abstract

Background

Cardiovascular 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.

Methods

MEDLINE (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.

Results

A 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 (I 2 = 93 %; p < 0.001).

Conclusions

The 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.
Appendix
Available only for authorised users
Literature
1.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095–128.CrossRefPubMed
2.
Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2197–223.CrossRefPubMed
3.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth. Arlington: American Psychiatic Publishing; 2013.
4.
Ruggeri M, Leese M, Thornicroft G, Bisoffi G, Tansella M. Definition and prevalence of severe and persistent mental illness. Br J Psychiatry. 2000;177:149–55.CrossRefPubMed
5.
Guideline development group of the Clinical Practice Guideline on Psychosocial Interventions in Severe Mental Illness. Clinical practice guideline on psychosocial interventions in severe mental illness. Madrid: Ministry of Health and Social Policy; 2009.
6.
De Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry. 2011;10:52–77.CrossRef
7.
Newcomer JW. Medical risk in patients with bipolar disorder and schizophrenia. J Clin Psychiatry. 2006;67:e16.CrossRefPubMed
8.
Pérez-Piñar M, Mathur R, Foguet Q, Ayis S, Robson J, Ayerbe L. Cardiovascular risk factors among patients with schizophrenia, bipolar, depressive, anxiety, and personality disorders. Eur Psychiatry. 2016;35:8–15.CrossRefPubMed
9.
Mainar A, Blanca-Tamayo M, Rejas-Gutiérrez J, Navarro- Artieda R. Metabolic syndrome in outpatients receiving antipsychotic therapy in routine clinical practice: a crosssectional assessment of a primary health care database. Eur Psychiatry. 2008;23:100–8.CrossRef
10.
Jomas BS, Franks P, Ingram DD. Are symptoms of anxiety and depression risk factors for hypertension? Longitudinal evidence from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Arch Fam Med. 1997;6:43–9.CrossRef
11.
Patten SB, Williams JV, Lavorato DH, Modgill G, Jetté N, Eliasziw M. Major depression as a risk factor for chronic disease incidence: longitudinal analyses in a general population cohort. Gen Hosp Psychiatry. 2008;30:407–11.CrossRefPubMed
12.
Gold KJ, Kilbourne AM, Valenstein M. Primary care of patients with serious mental illness: your chance to make a difference. J Fam Pract. 2008;57:515–25.PubMed
13.
Bobes J, Sáiz J, Montes JM, Mostaza J, Rico-Villademoros F, Vieta E. Consenso Español de Salud Física del Paciente con Trastorno bipolar. Rev Psiquatr Salud Ment (Barc). 2008;1:26–37.CrossRef
14.
Ruetsch O, Viala A, Bardou H, Martin P, Vacheron MN. Psychotropic drugs induced weight gain: a review of the literature concerning epidemiological data, mechanisms and management. Encéphale. 2005;31(4 Pt 1):507–16.CrossRefPubMed
15.
Taylor D. Antidepressant drugs and cardiovascular pathology: a clinical overview of affectiveness and safety. Acta Psychiatr Scand. 2008;118:434–42.CrossRefPubMed
16.
Kaplan NM. Clinical hypertension. 5th ed. Madrid: Lippincott Williams&Wilkins; 2006.
17.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.CrossRefPubMed
18.
Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(6), e1000097.CrossRefPubMedPubMedCentral
19.
Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4(10):e297.CrossRefPubMedPubMedCentral
20.
Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;8:18.CrossRefPubMedPubMedCentral
21.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.CrossRefPubMed
22.
Allan CL, Sexton CE, Kalu UG, McDermott LM, Kivimäki M, Singh-Manoux A, et al. Does the Framingham Stroke Risk Profile predict white-matter changes in late-life depression? Int Psychogeriatr. 2012;24(4):524–31.CrossRefPubMed
23.
McLean G, Martin JL, Martin DJ, Guthrie B, Mercer SW, Smith DJ. Standard cardiovascular disease risk algorithms underestimate the risk of cardiovascular disease in schizophrenia: evidence from a national primary care database. Schizophr Res. 2014;159(1):176–81.CrossRefPubMed
24.
Goff DC, Sullivan LM, McEvoy JP, Meyer JM, Nasrallah HA, Daumit GL, et al. A comparison of ten-year cardiac risk estimates in schizophrenia patients from the CATIE study and matched controls. Schizophr Res. 2005;80(1):45–53.CrossRefPubMed
25.
Mackin P, Bishop D, Watkinson H, Gallagher P, Ferrier IN. Metabolic disease and cardiovascular risk in people treated with antipsychotics in the community. Br J Psychiatry. 2007;191:23–9.CrossRefPubMed
26.
Margari F, Lozupone M, Pisani R, Pastore A, Todarello O, Zagaria G, et al. Metabolic syndrome: differences between psychiatric and internal medicine patients. Int J Psychiatry Med. 2013;45(3):203–26.CrossRefPubMed
27.
McCreadie RG, Scottish Schizophrenia Lifestyle Group. Diet, smoking and cardiovascular risk in people with schizophrenia: descriptive study. Br J Psychiatry. 2003;183:534–9.CrossRefPubMed
28.
Ratliff JC, Palmese LB, Reutenauer EL, Srihari VH, Tek C. Obese schizophrenia spectrum patients have significantly higher 10-year general cardiovascular risk and vascular ages than obese individuals without severe mental illness. Psychosomatics. 2013;54(1):67–73.CrossRefPubMedPubMedCentral
29.
Tay YH, Nurjono M, Lee J. Increased Framingham 10-year CVD risk in Chinese patients with schizophrenia. Schizophr Res. 2013;147(1):187–92.CrossRefPubMed
30.
De Hert M, Dekker JM, Wood D, Kahl KG, Holt RI, Moller HJ. Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). Eur Psychiatry. 2009;24:412–24.CrossRefPubMed
31.
Osborn DP, Wright CA, Levy G, King MB, Deo R, Nazareth I. Relative risk of diabetes, dyslipidaemia, hypertension and the metabolic syndrome in people with severe mental illnesses: systematic review and metaanalysis. BMC Psychiatry. 2008;8:84.CrossRefPubMedPubMedCentral
32.
Foguet Boreu Q, Roura Poch P, Bullón Chia A, Mauri Martin C, Gordo Serra N, Costa RC; en representación del grupo de Riesgo Cardiovascular en Trastorno Mental Severo (RISCA-TMS). Cardiovascular risk factors, cardiovascular risk and quality of life in patients with a severe mental disorder. Aten Primaria. 2013;45(3):141–8.CrossRefPubMed
33.
Castillo-Sánchez M, Fàbregas-Escurriola M, Bergè-Baquero D, Foguet-Boreu Q, Fernández-San Martín MI, Goday-Arno A. Schizophrenia, antipsychotic drugs and cardiovascular risk: Descriptive study in primary care. Eur Psychiatry. 2015;30(4):535–41.CrossRefPubMed
34.
Clerici M, Bartoli F, Carretta D, Crocamo C, Bebbington P, Carrà G. Cardiovascular risk factors among people with severe mental illness in Italy: a cross-sectional comparative study. Gen Hosp Psychiatry. 2014;36(6):698–702.CrossRefPubMed
35.
Chapman S, Ragg M, McGeechan K. Citation bias in reported smoking prevalence in people with schizophrenia. Aust N Z J Psychiatry. 2009;43(3):277–82.CrossRefPubMed
36.
Osborn DP, Nazareth I, King MB. Risk for coronary heart disease in people with severe mental illness: cross-sectional comparative study in primary care. Br J Psychiatry. 2006;188:271–7.CrossRefPubMed
37.
Cohn T, Prud'homme D, Streiner D, Kameh H, Remington G. Characterizing coronary heart disease risk in chronic schizophrenia: high prevalence of the metabolic syndrome. Can J Psychiatry. 2004;49(11):753–60.PubMed
38.
Fan Z, Wu Y, Shen J, Ji T, Zhan R. Schizophrenia and the risk of cardiovascular diseases: a meta-analysis of thirteen cohort studies. J Psychiatr Res. 2013;47(11):1549–56.CrossRefPubMed
39.
Van der Kooy K, van Hout H, Marwijk H, Marten H, Stehouwer C, Beekman A. Depression and the risk for cardiovascular diseases: systematic review and metaanalysis. Int J Geriatr Psychiatry. 2007;22(7):613–26.CrossRefPubMed
40.
Osborn DP, Hardoon S, Omar RZ, Holt RI, King M, Larsen J, et al. Cardiovascular risk prediction models for people with severe mental illness: results from the prediction and management of cardiovascular risk in people with severe mental illnesses (PRIMROSE) research program. JAMA Psychiatry. 2015;72(2):143–51.CrossRefPubMedPubMedCentral
41.
Correll CU, Detraux J, De Lepeleire J, De Hert M. Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry. 2015;14(2):119–36.CrossRefPubMedPubMedCentral
42.
Hartling L, Abou-Setta AM, Dursun S, Mousavi SS, Pasichnyk D, Newton AS. Antipsychotics in adults with schizophrenia: comparative effectiveness of first-generation versus second-generation medications: a systematic review and meta-analysis. Ann Intern Med. 2012;157(7):498–511.CrossRefPubMed
43.
Acharya T, Acharya S, Tringali S, Huang J. Association of antidepressant and atypical antipsychotic use with cardiovascular events and mortality in a veteran population. Pharmacotherapy. 2013;33(10):1053–61.CrossRefPubMed
44.
Arango C, Bobes J, Kirkpatrick B, Garcia-Garcia M, Rejas J. Psychopathology, coronary heart disease and metabolic syndrome in schizophrenia spectrum patients with deficit versus non-deficit schizophrenia: findings from the CLAMORS study. Eur Neuropsychopharmacol. 2011;21(12):867–75.CrossRefPubMed
45.
Bernardo M, Cañas F, Banegas JR, Casademont J, Riesgo Y, Varela C; RICAVA Study Group. Prevalence and awareness of cardiovascular risk factors in patients with schizophrenia: a cross-sectional study in a low cardiovascular disease risk geographical area. Eur Psychiatry. 2009;24(7):431–41.CrossRefPubMed
46.
Correll CU, Frederickson AM, Kane JM, Manu P. Metabolic syndrome and the risk of coronary heart disease in 367 patients treated with second-generation antipsychotic drugs. J Clin Psychiatry. 2006;67(4):575–83.CrossRefPubMed
47.
Correll CU, Kane JM, Manu P. Obesity and coronary risk in patients treated with second-generation antipsychotics. Eur Arch Psychiatry Clin Neurosci. 2011;261(6):417–23.CrossRefPubMedPubMedCentral
48.
Daumit GL, Goff DC, Meyer JM, Davis VG, Nasrallah HA, McEvoy JP, Rosenheck R, Davis SM, Hsiao JK, Stroup TS, Lieberman JA. Antipsychotic effects on estimated 10-year coronary heart disease risk in the CATIE schizophrenia study. Schizophr Res. 2008;105(1–3):175–87.CrossRefPubMedPubMedCentral
49.
Dickerson FB, Yu A, Dalcin A, Jerome GJ, Gennusa 3rd JV, Charleston J, et al. Cigarette smoking and health characteristics in individuals with serious mental illness enrolled in a behavioral weight loss trial. J Dual Diagn. 2013;9(1):39–46.CrossRefPubMedPubMedCentral
50.
Druss BG, von Esenwein SA, Compton MT, Rask KJ, Zhao L, Parker RM. A. The primary care access, referral, and evaluation (PCARE) study. Am J Psychiatry. 2010;167(2):151–931.CrossRefPubMedPubMedCentral
51.
Ferreira L, Belo A, Abreu-Lima C. A case-control study of cardiovascular risk factors and cardiovascular risk among patients with schizophrenia in a country in the low cardiovascular risk region of Europe. Rev Port Cardiol. 2010;29(10):1481–93.PubMed
52.
Garcia-Portilla MP, Saiz PA, Bascaran MT, Martínez AS, Benabarre A, Sierra P, et al. Cardiovascular risk in patients with bipolar disorder. J Affect Disord. 2009;115(3):302–8.CrossRefPubMed
53.
Goodrich DE, Kilbourne AM, Lai Z, Post EP, Bowersox NW, Mezuk B, et al. Design and rationale of a randomized controlled trial to reduce cardiovascular disease risk for patients with bipolar disorder. Contemp Clin Trials. 2012;33(4):666–78.CrossRefPubMed
54.
Grover S, Nebhinani N, Chakrabarti S, Avasthi A, Basu D, Kulhara P, et al. Cardiovascular risk factors among bipolar disorder patients admitted to an inpatient unit of a tertiary care hospital in India. Asian J Psychiatr. 2014;10:51–5.CrossRefPubMed
55.
Hoffman BM, Sherwood A, Smith PJ, Babyak MA, Doraiswamy PM, Hinderliter A, et al. Cardiovascular disease risk, vascular health and erectile dysfunction among middle-aged, clinically depressed men. Int J Impot Res. 2010;22(1):30–5.CrossRefPubMedPubMedCentral
56.
Jin H, Folsom D, Sasaki A, Mudaliar S, Henry R, Torres M, et al. Increased Framingham 10-year risk of coronary heart disease in middle-aged and older patients with psychotic symptoms. Schizophr Res. 2011;125(2–3):295–9.CrossRefPubMedPubMedCentral
57.
Nurjono M, Tay YH, Lee J. The relationship between serum brain-derived neurotrophic factor (BDNF) and cardiometabolic indices in schizophrenia. Schizophr Res. 2014;157(1–3):244–8.CrossRefPubMed
58.
Protopopova D, Masopust J, Maly R, Valis M, Bazant J. The prevalence of cardiometabolic risk factors and the ten-year risk of fatal cardiovascular events in patients with schizophrenia and related psychotic disorders. Psychiatr Danub. 2012;24(3):307–13.PubMed
59.
Said MA, Sulaiman AH, Habil MH, Das S, Bakar AK, Yusoff RM, et al. Metabolic syndrome and cardiovascular risk among patients with schizophrenia receiving antipsychotics in Malaysia. Singapore Med J. 2012;53(12):801–7.PubMed
60.
Stroup TS, Byerly MJ, Nasrallah HA, Ray N, Khan AY, Lamberti JS, et al. Effects of switching from olanzapine, quetiapine, and risperidone to aripiprazole on 10-year coronary heart disease risk and metabolic syndrome status: results from a randomized controlled trial. Schizophr Res. 2013;146(1–3):190–5.CrossRefPubMedPubMedCentral
61.
Sicras-Mainar A, Rejas-Gutiérrez J, Navarro-Artieda R, Blanca-Tamayo M. C-reactive protein as a marker of cardiovascular disease in patients with a schizophrenia spectrum disorder treated in routine medical practice. Eur Psychiatry. 2013;28(3):161–7.CrossRefPubMed
62.
Slomka JM, Piette JD, Post EP, Krein SL, Lai Z, Goodrich DE, et al. Mood disorder symptoms and elevated cardiovascular disease risk in patients with bipolar disorder. J Affect Disord. 2012;138(3):405–8.CrossRefPubMedPubMedCentral
63.
Smith PJ, Blumenthal JA, Babyak MA, Hoffman BM, Doraiswamy PM, Waugh R, et al. Cerebrovascular risk factors, vascular disease, and neuropsychological outcomes in adults with major depression. Psychosom Med. 2007;69(6):578–86.CrossRefPubMedPubMedCentral
64.
Taylor V, McKinnon MC, Macdonald K, Jaswal G, Macqueen GM. Adults with mood disorders have an increased risk profile for cardiovascular disease within the first 2 years of treatment. Can J Psychiatry. 2010;55(6):362–8.PubMed
65.
Wysokiński A, Kowman M, Kłoszewska I. The prevalence of metabolic syndrome and Framingham cardiovascular risk scores in adult inpatients taking antipsychotics - a retrospective medical records review. Psychiatr Danub. 2012;24(3):314–22.PubMed
66.
Zuidersma M, Izaks GJ, Naarding P, Comijs HC, Oude Voshaar RC. Vascular burden and cognitive function in late-life depression. Am J Geriatr Psychiatry. 2015;23(5):514–24.CrossRefPubMed
Metadata
Title
Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis
Authors
Quintí Foguet-Boreu
Maria Isabel Fernandez San Martin
Gemma Flores Mateo
Edurne Zabaleta del Olmo
Luís Ayerbe García-Morzon
Maria Perez-Piñar López
Luis Miguel Martin-López
Javier Montes Hidalgo
Concepción Violán
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2016
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-016-0833-6

Other articles of this Issue 1/2016

BMC Psychiatry 1/2016 Go to the issue

Case report

Eosinophilic myocarditis during treatment with olanzapine - report of two possible cases

Research article

Integrated care in German mental health services as benefit for relatives – a qualitative study

Study protocol

An integrated workplace mental health intervention in a policing context: Protocol for a cluster randomised control trial

Research article

Personality disorders and Axis I comorbidity in adolescent outpatients with ADHD

Research article

Magnitude and associated factors of aggressive behaviour among patients with bipolar disorder at Amanual Mental Specialized Hospital, outpatient department, Addis Ababa, Ethiopia: cross-sectional study

Research article

Gender moderates the relationship between childhood abuse and internalizing and substance use disorders later in life: a cross-sectional analysis