Mental Illness Puts Veterans at Higher Risk of Heart Disease

Please click image to enlarge (Adapted from Vance MC. Circ Cardiovasc Qual Outcomes. 2019;12:e005563)

Specific mental illnesses in veterans heightens their risk of heart attack, stroke, and death from cardiovascular disease (CVD), with more severe conditions further increasing this risk, according to a new study.

The link between mental illness and CVD risk has been demonstrated by previous studies, but few have compared which disorders have the strongest association with CVD risk.

Authors of the new large prospective study, published September 24 in Circulation: Cardiovascular Quality and Outcomes, sought to examine the association of various mental illnesses – depression, anxiety, post-traumatic stress disorder (PTSD), psychosis, and bipolar disorder – with major CVD outcomes.

“This study confirms the findings from previous literature that depression, psychosis, and bipolar disorder are all associated with an increased CVD risk,” wrote researchers led by Mary C. Vance, MD, MSc, assistant professor of psychiatry, Uniformed Services University, Bethesda, Maryland.

Researchers analyzed data from >1.6 million veterans (~1.5 million men; ~94 000 women) who received care in the Department of Veterans Affairs healthcare system between 2010 and 2014.

The mean age of participants was 61.6 years; 68% were white; ~45% of men and ~63% of women had any psychiatric diagnosis at baseline.

Results

Over 5 years, men with any psychiatric diagnosis had a lower risk of CVD events and a higher risk of CVD death vs men without any psychiatric diagnosis. Women with any psychiatric diagnosis had a higher risk of both major CVD outcomes vs women without any psychiatric diagnosis.

After adjusting for age, “both men and women with any psychiatric diagnosis had a significantly higher risk of CVD events and CVD mortality,” researchers stated. “This finding generally persisted after controlling for traditional CVD risk factors.”

In the model adjusted for all psychiatric diagnoses, researchers found:

• Men with depression, psychosis, bipolar disorder, and anxiety had a significantly higher risk of major CVD outcomes; PTSD was linked to a slight but statistically significant decreased risk of major CVD outcomes, contrary to previous studies. 

• Women with depression, psychosis, and bipolar disorder had a significantly increased risk of CVD events; psychosis and bipolar disorder were associated with a significantly increased risk of CVD death.

• Psychosis posed the highest risk for major CVD outcomes in both cohorts. 

Results also showed that black men diagnosed with any psychiatric disorder had a lower risk for CVD events and CVD death vs white men and men of other races with any psychiatric diagnoses.

Overall, mental disorders had stronger associations with CVD mortality vs events, which the researchers attributed to people with mental illness being more likely to present in later stages of illness vs those without mental disorders – thus increasing their risk of CVD death.

“The bottom line is that when considering a veteran’s health care needs, mental health status, especially for more severe mental illnesses, should be taken into consideration when calculating cardiovascular disease risk and considering the appropriate treatment options,” Vance told the American Heart Association in an interview.