Cardiovascular risk assessment with SCORE2 and targeted health dialogues in primary care patients with mental illness

Patients with mental illness face a higher risk of cardiovascular disease (CVD), mainly due to unhealthy lifestyle habits. The CVD risk assessment tool Systematic COronary Risk Evaluation 2 (SCORE2) does not assess modifiable lifestyle factors beyond smoking. In Sweden, Targeted Health Dialogues (THD) are used in primary care as a structured, person-centred approach designed to evaluate lifestyle behaviours that influence CVD risk. Unlike SCORE2, the THD assesses a broader set of modifiable lifestyle-related cardiovascular risk factors, including BMI, waist-hip ratio, diet quality, physical activity, alcohol and nicotine use, sleep, and fasting biomarkers such as glucose and lipids. This study explored whether THD can add value in identifying cardiovascular risk factors in patients with mental illness, beyond what is captured by SCORE2.

This cross-sectional study included 120 patients, aged 40-69, with mental illness in Swedish primary care. CVD risk factors were assessed with a THD. SCORE2 was calculated, and the well-known CVD risk factors according to THD were compared across SCORE2 risk levels in men and women separately.

Most men (86.5%) and one-third (35.5%) of the women had moderate or high CVD risk according to SCORE2. Many patients with increased SCORE2 risk also had other risk factors identified through THD. A large proportion of both sexes with a low SCORE2 risk had several unhealthy modifiable risk factors (including high WHR, BMI, and physical inactivity).

In conclusion, Targeted Health Dialogues may complement SCORE2 by identifying additional modifiable lifestyle-related risk factors relevant to cardiovascular prevention in patients with mental illness. Further research, including longitudinal and interventional designs, is warranted to evaluate whether THD-guided lifestyle counselling can reduce cardiovascular risk in this population.