Increased Cardiovascular Disease Risk in Veterans With Mental Illness
Mary C Vance1, Wyndy L Wiitala2, Jeremy B Sussman3,2
1From the Department of Psychiatry, Uniformed Services University, Bethesda, MD (M.C.V.).
Insights
Severe mental illnesses like psychosis significantly increase the risk of cardio-cerebrovascular disease (CVD) events and mortality in both men and women. This highlights the critical link between mental health conditions and cardiovascular health outcomes.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Previous research indicates a link between mental illnesses and cardio-cerebrovascular disease (CVD) risk.
- However, studies comparing the relative strength of association between different mental illnesses and CVD risk are limited.
Purpose of the Study:
- To assess the association of various psychiatric diagnoses with major CVD outcomes.
- To compare the strength of association between different mental illnesses and CVD risk.
Main Methods:
- Utilized a national primary prevention cohort of military veterans (approx. 1.52 million men, 94,000 women) from VA, CMS, and CDC databases.
- Employed multiple logistic regression to analyze psychiatric diagnoses (psychosis, bipolar disorder, depression, anxiety, PTSD) and CVD outcomes (events, mortality) over 5 years.
- Adjusted for sex, other psychiatric diagnoses, age, race, conventional CVD risk factors, and medication use.
Main Results:
- Among men, depression, psychosis, and bipolar disorder predicted CVD events and mortality; psychosis had the largest effect size.
- Among women, psychosis and bipolar disorder predicted CVD events and mortality; psychosis showed the largest effect size.
- Anxiety was linked to CVD mortality in men, while depression was linked to CVD events in women.
Conclusions:
- Multiple mental illnesses are associated with increased CVD risk, supporting the chronic stress hypothesis.
- More severe mental illnesses, such as primary psychotic disorders, demonstrated the largest effect sizes for CVD outcomes.
- These associations remained significant after controlling for other psychiatric diagnoses, CVD risk factors, and medication use.
Background:
Although previous studies have demonstrated an association between various mental illnesses and cardio-cerebrovascular disease (CVD) risk, few have compared the strength of association between different mental illnesses and CVD risk.
Methods And Results:
We assessed the association of psychiatric diagnoses (psychosis, bipolar disorder, depression, anxiety, and posttraumatic stress disorder) with major CVD outcomes (CVD events and CVD mortality) over 5 years, using a national primary prevention cohort of military veterans receiving care in the Department of Veterans Affairs. Data were linked from the Department of Veterans Affairs, Centers for Medicare and Medicaid Services, and Centers for Disease Control and Prevention National Death Index databases. We used multiple logistic regression to examine how the presence of a psychiatric diagnosis at baseline (2005-2009) was associated with CVD outcomes over the next 5 years (January 1, 2010, to December 31, 2014) stratified by sex, adjusting for other psychiatric diagnoses, as well as age, race, conventional CVD risk factors as calculated by the Veterans Affairs Risk Score-CVD, and antipsychotic and anticonvulsant/mood stabilizer medication prescriptions. Approximately 1.52 million men and over 94 000 women met our inclusion criteria. In the fully adjusted model, among men, we found that depression, psychosis, and bipolar disorder were predictive of both CVD events and CVD mortality, with psychosis having the largest effect size (eg, adjusted odds ratio, 1.48; CI, 1.41-1.56; P<0.001 for psychosis and CVD mortality). Among women, only psychosis and bipolar disorder were predictive of both CVD events and CVD mortality, again with psychosis having the largest effect size (eg, adjusted odds ratio, 1.97; CI, 1.52-2.57; P<0.001 for psychosis and CVD mortality). Anxiety was associated with only CVD mortality in men, and depression was associated with only CVD events in women.
Conclusions:
Consistent with the hypothesis that chronic stress leads to greater CVD risk, multiple mental illnesses were associated with an increased risk of CVD outcomes, with more severe mental illnesses (eg, primary psychotic disorders) having the largest effect sizes even after controlling for other psychiatric diagnoses, conventional CVD risk factors, and psychotropic medication use.
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