May 30, 2014 – Researchers believe that interventions with known efficacy for lowering the risk of heart disease in the general population may translate to similar results in people with SMI.
Heart disease is a leading cause of death in patients with serious mental illness (SMI), and many studies have found that patients with SMI have less access to preventive health care treatments than patients with less severe mental disorders. Despite the increased risk of heart disease in this population, a new comparative effectiveness review found that very few studies have evaluated treatments for cardiovascular disease risk factors in these patients.
The study results were published in the May issue of the Journal of Clinical Psychiatry. The DCRI’s Amanda McBroom, PhD, and Vic Hasselblad, PhD, were among the authors.
People who suffer from SMI have shortened life expectancies and higher rates of other diseases, including diabetes and heart disease, compared with the general population. Obesity, lack of exercise, and smoking are all risk factors associated with cardiovascular disease, all of which are prevalent among adults with SMI. These could be contributing factors to the increased risk for heart disease among these patients. Other factors could include side effects of drugs used to treat SMI and the fact that patients with SMI usually receive health care treatment in specialized mental hospitals and often do not have regular access to general medical care.
The comparative effectiveness study evaluated medication and behavioral measures taken to reduce heart-disease risk in adults with SMI. Relatively few studies have been done in this area, and most have focused on weight control. Out of the 33 studies reviewed, effects on physical function were reported infrequently, and overall heart-disease risk and death in SMI patients from all causes were not reported. Although many medications used by these patients were evaluated in the studies, most medications that are known to effectively control risk factors for heart disease were not.
Researchers found that treatments tested in SMI populations had similar effects on weight and other outcomes found in patients without mental illnesses. They believe that interventions with known efficacy for lowering the risk of heart disease in the general population may translate to similar results in people with SMI, but further study is needed. However, some medications will interact with antipsychotic medications and be less effective.
The researchers concluded that more studies are needed that test combining treatments, known effective medications in non-SMI populations, and antipsychotic-treatment strategies. Increasing guideline-recommended care for individuals with SMI—given the current lack of evidence for SMI-specific interventions—could be considered a starting point for minimizing heart-disease risk in patients with SMI; guidelines for the general population should then be modified to consider the special risks for patients with SMI.