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Mental illness and obesity among Veterans undergoing percutaneous coronary intervention: Insights from the VA CART
Diana P Brostow1,2, Theodore J Warsavage1, Lauren M Abbate3,4
1Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA.
Insights
Mental illness increases major adverse cardiac and cerebrovascular events (MACCE) risk after percutaneous coronary intervention (PCI). Obesity, however, is linked to fewer MACCE, with no significant interaction between mental illness and weight status.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Coronary artery disease (CAD) patients frequently have comorbid mental illness and obesity.
- Mental illness is a known risk factor for major adverse cardiac and cerebrovascular events (MACCE).
- Obesity's impact on MACCE in CAD patients is less clear, with some studies suggesting better outcomes.
Purpose of the Study:
- To investigate the independent and interactive effects of obesity and mental illness on MACCE in patients undergoing percutaneous coronary intervention (PCI).
- To determine if weight status and psychiatric diagnoses influence cardiac outcomes post-PCI.
Main Methods:
- Analysis of 55,091 patients undergoing PCI between 2009-2014 from the Veterans Affairs (VA) Clinical Assessment Reporting and Tracking (CART) program.
- Utilized Cox proportional hazards models to assess MACCE risk associated with weight status and psychiatric diagnoses.
- Evaluated potential interactions between obesity and mental illness on MACCE outcomes.
Main Results:
- Higher weight status was associated with a significant reduction in MACCE post-PCI for both stable angina (>13%) and acute coronary syndromes (ACS) (>17%).
- A non-substance abuse mental illness diagnosis increased MACCE risk in stable angina patients by over 17% but not in ACS patients.
- No significant interaction was found between obesity and mental illness; their effects on MACCE were independent.
Conclusions:
- Mental illness is an independent risk factor for MACCE in patients after PCI, particularly in stable angina.
- Obesity appears to be associated with reduced MACCE post-PCI, independent of mental health status.
- Clinicians must consider mental health status as a critical cardiovascular risk factor in patients post-PCI, irrespective of their weight.
Abstract:
Mental illness and obesity are highly prevalent in patients with coronary disease and are frequently comorbid. While mental illness is an established risk factor for major adverse cardiac and cerebrovascular events (MACCEs), prior studies suggest improved outcomes in people with obesity. It is unknown if obesity and mental illness interact to affect cardiac outcomes or if they independently influence MACCE. We identified 55 091 patients undergoing percutaneous coronary intervention (PCI) between 2009 and 2014, using the Veterans Affairs (VA) Clinical Assessment Reporting and Tracking (CART) program. Cox methods were used to assess the risk of MACCE by weight status and psychiatric diagnosis, and assessed for interaction. Compared to normal weight status, higher weight was associated with reduced MACCE events after PCI (mean follow-up of 2 years) for both stable angina and acute coronary syndromes (ACSs; reduction of >13% in stable angina, >17% in ACS; P < 0.01 for both after adjustment). Having a non-substance abuse mental illness diagnosis increased risk of MACCE compared to patients without mental illness in stable angina over 17%; P < 0.05, but not in ACS. When analysed for interaction, obesity and mental illness did not significantly impact MACCE over their independent influences. These results suggest that mental illness along with weight status have significant impact on MACCE, post-PCI. Clinicians should be aware of patients' mental health status as a significant cardiovascular risk factor after PCI, independent of weight status.
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