Risk for coronary heart disease in people with severe mental illness

BACKGROUND: Despite concern about the incidence of coronary heart disease (CHD) in people with severe mental illness (SMI), there is little systematic research on CHD risk factors in this population. AIMS: To compare the main risk factors for CHD in people with and without SMI in primary care, to investigate the role of socio-economic variables, and to examine any association between antipsychotic medication and CHD risk. METHOD: Cross-sectional screening. RESULTS: In total, 75 of 182 general practice patients with SMI and 150 of 313 such patients without SMI attended the interview. SMI was associated with: raised 10-year CHD risk scores (OR=1.8,95% CI 1.0-3.1); high-density-lipoprotein (HDL)-cholesterol levels <1.0 mmol/l (OR=4.0, 95% CI 1.5-10.7); raised cholesterol/HDL-cholesterol ratios (OR=1.8,95% CI 1.0-3.2); diabetes mellitus (OR=3.8,95% CI 1.1-13.3) and smoking (OR=3.0,95% CI 1.7-3.4). These associations varied significantly with age. Adjustment for unemployment did not fully explain the associations. CONCLUSIONS: Excess risk factors for CHD are not wholly accounted for by medication or socio-economic deprivation. There is an urgent need for CHD screening and for relevant interventions for smoking cessation and diabetes, as well as advice on diet and exercise, in patients with SMI.