People with mental health disorders twice as likely to have heart disease or stroke

"This population is at high risk, and it's even greater for people with multiple mental health issues," says Dr. Katie Goldie, lead author of the study and a postdoctoral fellow at the Centre for Addiction and Mental Health in Toronto

Using data from the Canadian Community Health Survey, Dr. Goldie explored the associations between cardiovascular risk and disease, mental health disorders and the use of psychiatric medication.

The study found that:

• People who have had a mental health disorder at any point in their life were twice as likely to have had heart disease or have experienced a stroke.
• Those who haven't developed heart disease or had a stroke are more likely to be at a high long-term risk of developing cardiovascular disease, when compared to the general population.
• People who used psychiatric medications were twice as likely to have heart disease and three times as likely to have had a stroke compared to those not taking these medications.

The study included people with schizophrenia, bipolar disorders, major depressive and anxiety disorders. Among the psychiatric drugs examined were antipsychotic, antidepressant, benzodiazepine and mood-stabilizing medications.

What accounts for the elevated risk? Dr. Goldie mentions three main factors:

First, people with mental health disorders often exhibit behavioural risk factors, including tobacco and alcohol use, poor diet and physical inactivity. For instance, she says 40 to 90 per cent of people with mental illness use tobacco, compared to 20 per cent of the general Canadian population.

Psychiatric medications can induce weight gain and impair the breakdown of fats and sugars by the body. This can lead to obesity, high cholesterol and diabetes. "The medications themselves account for a lot of risk in this group," she says.

A third issue is access to health care. Patients with mental health disorders may have difficulty communicating their health needs. "Or they may not even seek care because of the symptoms of their disorder," says Dr. Goldie. "A separation between primary and mental health services can also challenge these patients' care. We need improved integration and collaboration."

She adds that there is still stigma associated with mental illness that can even affect the care health professionals provide. Dr. Goldie says that people with mental health disorders are less likely to receive risk-reducing drug therapies or undergo coronary procedures such as bypass surgery.

With one in five Canadians experiencing a mental health disorder in their lifetime, this is an urgent issue for cardiovascular health. Dr. Goldie, who is also an adjunct assistant professor at the Queen's University School of Nursing in Kingston, says that healthcare providers need to pay even closer attention to patients with mental health disorders.

Healthcare providers can improve the cardiovascular health of their patients by being vigilant in conducting routine cardiovascular risk assessments, before and after initiating psychopharmacological treatment, in addition to offering health promotion interventions to target known cardiovascular risk factors.

It is very important that people have their mental health issues treated and also be proactive in speaking with their care providers about their overall health, says Heart and Stroke Foundation spokesperson Dr. Brian Baker, a psychiatrist who specializes in people with cardiac disease.

"The prevention strategies are the same for people with mental health issues," says Dr. Baker. "That means eating a healthy diet, being physically active, being smoke-free, managing stress and limiting alcohol consumption. Making positive health behaviour changes is important to our physical health and to mental health too."

He adds that ongoing follow-up with medical professionals is essential and that even if certain medications can have some risks, the benefits often outweigh the risks, so it is important that people talk to their doctors, continue to take their prescribed medications and follow healthy behaviours.

The Canadian Cardiovascular Congress is co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.