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EASD: Link Between Severe Mental Illness, CVD, Diabetes

Oct 4, 2009

European organizations are calling for improved care and screening for CVD and diabetes in those with mental illnesses.

People with severe mental illnesses, such as schizophrenia, depression and bipolar disorder, die about 10 to 20 years prematurely compared with the general population, and the most common cause of death is cardiovascular disease, experts said.

A joint statement issued by the European Association for the Study of Diabetes, European Society of Cardiology and European Psychiatric Association emphasizes the link between mental illness and CVD, with the goal of increasing awareness, improving care and initiating cooperation and screening.

Richard Holt, MD, PhD, from the University of Southampton, United Kingdom, said, “In addition to having the devastating effects of severe mental illness, people with schizophrenia and bipolar disorder die prematurely.”

People with mental illness find it much harder to access physical health services, Holt noted. “Rates of screening for both diabetes and CVD are significantly less than in the general population,” he said. “While maybe 20% of cases of diabetes are unknown in the general population, among people with mental illness, as many as 70% are undiagnosed.”

Although suicide and trauma are well-recognized causes of mortality in this population, physical illnesses account for about three-quarters of all deaths, including CVD, according to Holt. Further, diabetes is two to three times more common among people with severe mental illness, and this may account for some of the excess risk of CVD, he said.

Much of the risk among people with severe mental illness can be attributed to lifestyle factors, according to Holt. The excess CV mortality can be attributed to modifiable coronary heart disease risk factors, including obesity, smoking, diabetes, hypertension and dyslipidemia.

Many people with severe mental illness have developed diabetes and CVD without recognition and without appropriate treatment due to a “lack of attention, lack of identification and lack of awareness,” added Ulf Smith, MD, PhD, president of the EASD.

The statement documents the relationship between mental illness, CVD and diabetes, and provides guidance for screening. This includes: details of any history of previous CVD, diabetes or other related disease; family history of premature CVD, diabetes or other related disease; smoking; clinical examination; measurement of weight and height in order to calculate BMI and waist circumference; blood testing to include fasting blood glucose, fasting blood lipids, total cholesterol, triglycerides, LDL and HDL; and electrocardiography.

Further, not only are diabetes and CVD more common in this population, but they may occur at a much younger age, according to Holt. “We need to start to screen for diabetes and CV risk factors from a much earlier age from the time of diagnosis,” he said.

In addition, antipsychotic medications and antidepressants may induce weight gain or worsen metabolic CV risk factors. However, antipsychotic drugs are an effective and necessary component of the management of schizophrenia and bipolar illness, Holt said in a press release.

Eur Psychiatry.De Hert M 2009;24:412-424.