Severely mentally ill have increased risk of death from coronary heart disease and stroke

A large British study indicates that individuals with severe mental illnesses are significantly more likely to die from coronary heart disease and stroke, but not cancer, than those without mental illnesses, according to a report in the February issue of Archives of General Psychiatry.

Physical health is a concern among those with severe mental illnesses, according to background information in the article. The adverse effects of antipsychotic medication, along with smoking, lifestyle factors and poverty, may contribute to physical illness in this population. However, estimates for rates of cancer and heart disease among the mentally ill have been conflicting.

David P.J. Osborn, Ph.D., and colleagues at the Royal Free and University College Medical School, London, selected 46,136 individuals with severe mental illness (including schizophrenia, schizoaffective disorder, bipolar disorder and delusional disorder) and 300,426 without mental illness from a nationally representative database in the United Kingdom. The researchers compared the two group's death rates from coronary heart disease, stroke and the seven most common types of cancer in the United Kingdom?respiratory, colorectal, breast, prostate, stomach, esophageal and pancreatic cancer. "We chose to study death rates rather than incidence rates, because mortality is the most robust outcome since it includes diagnoses made post-mortem," the authors write.

Over a follow-up period of at least six months, individuals of all ages were significantly more likely to die from coronary heart disease and stroke if they had a severe mental illness. Those with severe mental illness age 18 to 49 were 3.22 times as likely to die from heart disease and 2.53 times as likely to die from stroke; those age 50 to 75 were 1.86 times more likely to die from heart disease and 1.89 times more likely to die from stroke, and those older than 75 were 1.05 times as likely to die from heart disease and 1.34 times as likely to die from stroke.

The rates did not change significantly after the researchers adjusted for smoking rates and social deprivation, both of which contribute to the risk for heart disease. The use of antipsychotic medication, however, did have an effect. "People with severe mental illness who were not prescribed any antipsychotics were at increased risk of coronary heart disease and stroke than controls, whereas those prescribed such agents were at even greater risk," the authors write. "Those receiving the higher doses were at greatest risk for death from both coronary heart disease and stroke."

"With the exception of respiratory tumors, people with severe mental illness were not at increased risk of dying from the seven most common cancers in the United Kingdom," they continue. "However, our data did not confirm other evidence that they were protected from cancers."

Additional research is needed to help prevent cardiovascular disease and death among those with severe mental illness, the authors conclude. "Clinically, a holistic approach to the care of people with severe mental illness is still frequently overlooked," they write. "Such an approach requires monitoring for somatic conditions and demands effective communication between primary and secondary care to provide coherent physical health care."