Keywords: severe mental disorders, cardiovascular incidence, sociodemografic factors
Background:
The prevalence of cardiovascular morbidity and mortality are more elevated in patients with severe mental disorders (SMD) than in general population
Research questions:
Our main objective is to estimate the incidence rates of cardiovascular events (CVE) in patients with SMD and to determine the sociodemographic factors that can be associated
Method:
Retrospective longitudinal study of a cohort of patients having SMD. Patients between 35 and 74 years assigned to primary care teams of the Catalan Institute of Health and who have been attended between 2007 and 2010 had been included. Exclusion criteria: history of CVE at baseline, lipid-lowering treatment at baseline. Sociodemografic baseline measurement from the anonymized database SIDIAP: gender, age, socioeconomic level according to geographic area, rural/urban area. At 12 years follow-up CVE (coronary heart disease: CHD; and stroke) were collected
Results:
A total of 22747 SMD patients who met the selection criteria were included: 46.7% had schizophrenia, 27.8% had bipolar disorder and 25.5% had other psychotic disorders. 49.1% were women, the average age was 47.9 years (SD:10).
Incidence rates of CVE per 1000 person-years: Global CVE 3.74 (IC95%: 3.46 – 4.03); CHD 1.79 (95%CI: 1.60 - 2.00); stroke 1.82 (95%CI: 1.62 - 2.25). CVE rates are higher in men, especially in the case of CHD. In all cases the incidence rates of CVE increase with age. The incidence rates of CVE are higher in the bipolar group, especially due to stroke. There are no differences in the incidence rates of CVE by socio-economic level or rurality
Conclusions:
The incidence of CVE in the SMD population is high and higher than the general population. There are differences in CVE rates according to gender and diagnostic groups. It is necessary to adjust according to cardiovascular risk factors to assess which ones are more relevant in each diagnostic and gender group
Points for discussion:
How is the prevalence of cardiovascular risk factors in the diagnostic groups?
Is there differences in CVE incidences between SMD and population according to gender?
Is there differences in CVE incidences according to socioeconomic level, adjusting for CV risk factors?