Severe Mental Illness and Risk of Cardiovascular Disease

countries, and will remain so during the 21st century.1 In 2004, CVD was listed as the underlying cause of death in 871 517 of all 2 398 000 deaths (36.3%), or 1 of every 2.8 deaths in the United States, with CHD accounting for 52% and stroke for 17%.2 During the past several decades, CVD mortality has markedly declined in the United States, from more than 50 % to approximately 36 % as the underlying cause of death. Recent data suggest that the decline is largely due to improved diagnosis and treatment rather than to major successes in primary prevention. In contrast, patients with severe mental illnesses, such as schizophre-nia, bipolar disorder, and depression that together affect 5% to 10 % of the US population,3 lose 25 or more years of life expectancy, with the majority of the excess premature deaths due to CVD, not suicide.4 In this Commentary, we summarize disparities in CVD mortality and prevention efforts comparing the general population and individuals with severe mental illnesses and suggest the urgent need for new paradigms. In the general US population, cigarette consumption has been the leading avoidable cause of all premature deaths, with the amount currently smoked representing a keymea-sure of risk.5 Smoking rates in the general population have declined from more than 50 % in the 1950s to approxi-mately 25 % at present.5 However, among patients with di-agnosable mental illness, 50 % to 80 % are smokers and con-sume 34 % to 44 % of all cigarettes in the United States.6 Although patients with severe mental illness are overrep-resented in state programs likeMedicaid, some states do not cover any form of tobacco-dependence treatment.7 In ad-dition, only a few states cover all treatments recommended in theUSPreventive Services Task Force guidelines on smok-ing cessation.7 Moreover, some states that cover tobacco-dependence treatment require cost sharing, a serious dis-incentive for disabled patients with fixed income.7