People with schizophrenia and bipolar disorder have a significantly higher risk of coronary heart disease (CHD) and other vascular diseases compared with the general population.

In schizophrenia the figures suggest a 50% higher risk of CHD in women and a 34% higher risk in men. The prevalence of a number of modifiable risk factors is the key to understanding the problem. It is estimated that over 90% of the risk can be attributed to factors that could be modified. For example, the estimated prevalence of obesity in schizophrenia is 42%. Other modifiable factors that contribute towards heart disease have been estimated as:

Smoking          54 to 75%

Diabetes          13 to 15%

Hypertension   19 to 60%

Dyslipidemia*   25%

*Dyslipidemia is a disorder of lipoprotein metabolism & is often manifested by an increase in total cholesterol levels.

In bipolar disorder these same modifiable factors have been estimated as:

Obesity            21 to 49%

Smoking          54 to 75%

Diabetes          13 to 15%

Hypertension   19 to 60%

Dyslipidemia*   25%

Colton & Manderscheid (2006) have assessed the average potential number of years lost by calculating for a 4 year period data from 7 States, from patients with mental illness. In cases of people with schizophrenia, it is estimated that the increased mortality rate due to vascular disease, equates to an average loss of 25 years from the expected lifespan.

The risk of CHD mortality in people with bipolar disorder is estimated at 1.9 times higher for men and 2.6 times higher for women.

Reducing Risk

There is increasing awareness that people with severe mental illness have tended to be overlooked in terms of their physical health. More information is needed with regard to the metabolic effects of medication on individuals, but greater emphasis needs to be placed by both health professional and caregivers on factors such as lifestyle, diet and exercise and the need to stop smoking.

References

Ösby U, Brandt L, Correia N, Ekbom A, Sparén P. Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry. 2001;58:844-850.

Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis. 2006;3:11-14.