Cardiovascular risk factors and 30-year cardiovascular risk in homeless adults with mental illness
Related Experiment Video
Updated: Apr 14, 2026
Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis
Published on: September 26, 2018
Agnes Gozdzik1, Roxana Salehi2, Patricia O'Campo3,4
1Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. gozdzikag@smh.ca.
Insights
Homeless individuals with mental illness face double the average 30-year risk of cardiovascular disease (CVD). This elevated risk is particularly pronounced in males and those with substance dependence, highlighting a critical public health concern.
Area of Science:
- Public Health
- Psychiatry
- Cardiology
Background:
- Cardiovascular disease (CVD) is a primary cause of mortality among the homeless population.
- Homeless individuals with mental illness represent a particularly vulnerable group with significant unmet health needs.
Purpose of the Study:
- To assess cardiovascular disease (CVD) risk factors and calculate the 30-year CVD risk in homeless individuals with mental illness.
- To identify specific demographic and clinical factors associated with elevated CVD risk in this population.
Main Methods:
- A cohort of 352 homeless individuals with mental illness in Toronto, Canada, were assessed for CVD risk factors.
- Thirty-year CVD risk was calculated using established formulas and analyzed in relation to mental health service needs, psychotic disorder diagnosis, sex, ethnicity, physician access, and substance dependence diagnosis.
Main Results:
- The study population exhibited a 30-year CVD risk of 24.5%, more than double the reference norm (10.1%).
- Male sex and diagnosis of substance dependence were significantly associated with increased 30-year CVD risk in both univariate and adjusted analyses.
- Non-white ethnicity was associated with reduced CVD risk in univariate analysis.
Conclusions:
- Homeless individuals with mental illness have substantially elevated 30-year CVD risk, with males and those with substance dependence being at highest risk.
- These findings underscore the need for targeted cardiovascular health interventions in this vulnerable population.
- Utilizing a 30-year CVD risk calculator offers a valuable timeframe for mitigating modifiable risk factors.
Background:
Cardiovascular disease (CVD) is a leading cause of death among homeless people. This study examines CVD risk factors and 30-year CVD risk in a population of homeless individuals with mental illness.
Methods:
CVD risks factors were assessed in 352 homeless individuals with mental illness in Toronto, Canada, at the time of their enrollment in the At Home/Chez Soi Project, a randomized trial of a Housing First intervention. The 30-year risk for CVD (coronary death, myocardial infarction, and fatal or nonfatal stroke) was calculated using published formulas and examined for association with need for mental health services, diagnosis of psychotic disorder, sex, ethnicity, access to a family physician and diagnosis of substance dependence.
Results:
The 30-year CVD risk for study participants was 24.5 ± 18.4%, more than double the reference normal of 10.1 ± 7.21% (difference = -13.0% 95% CI -16.5% to -9.48%). Univariate analyses revealed 30-year CVD risk was greater among males (OR 3.99, 95% CI 2.47 to 6.56) and those who were diagnosed with substance dependence at baseline (OR 1.94 95% CI 1.23 to 3.06) and reduced among those who were non-white (OR 0.62 95% CI 0.39 to 0.97). In adjusted analyses, only male sex (OR 4.71 95% CI 2.76 to 8.05) and diagnosis of substance dependence (OR 1.78 95% CI 1.05 to 3.00) remained associated with increased CVD risk.
Conclusions:
Homeless people with mental illness have highly elevated 30-year CVD risk, particularly among males and those diagnosed with substance dependence. This study adds to the literature by reporting on CVD risk in a particularly vulnerable population of homeless individuals experiencing mental illness, and by using a 30-year CVD risk calculator which provides a longer time-frame during which the effect of modifiable CVD risk factors could be mitigated.
Trial Registration:
Current Controlled Trials ISRCTN42520374.
Related Concept Videos
01:27Psychoneuroimmunology: Cardiovascular Disease
A key area of focus in PNI is the relationship between stress and coronary...
01:30Coronary Artery Disease I: Introduction
01:23Assessment of the Cardiovascular System I: Subjective Data
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
01:27Heart Failure I: Introduction
01:26Stress Prevention and Stress Management Techniques IV
01:26Coronary Artery Disease IV: Preventive Measures