Psychiatric illness and cardiovascular disease risk

Studies evaluating the risk of cardiovascular disease in the psychiatrically ill yield mixed results. Phobic anxiety in men is associated with an increased risk for cardiovascular disease, particularly sudden coronary death. This finding is in need of replication in women, and hypotheses regarding the potential mechanisms for this association warrant pilot testing. Other than this finding, there is only weak evidence supporting an association between psychiatric illness and risk for cardiovascular disease. This is surprising in light of the strong evidence that psychiatric illness in general is associated with elevated rates of cigarette smoking. In addition, there may also be higher rates of hypertension, hypercholesterolemia, and physical inactivity in some psychiatric disorders. Why the high rates of cigarette smoking and possibly other cardiovascular disease risk factors have not translated into consistently detectable elevated cardiovascular disease risk in individuals with psychiatric diagnoses is not apparent. Weaknesses in study designs and variations in assessment methods may partially explain the inconsistent results. Future studies of cardiovascular disease in the psychiatrically ill should be prospective, use nonclinical samples of men and women, have clear diagnostic criteria, determine order of onset of the two disorders if they coexist, and control for variability in known cardiovascular disease risk factors.