Veterans with Mental Health Conditions at Higher Risk of Heart Disease, Stroke

According to new research published in Circulation: Cardiovascular Quality and Outcomes and the American Heart Association journal, veterans with specific mental health conditions, including depression, psychosis, and bipolar disorder, had an increased risk of heart attack, stroke, and death from cardiovascular disease.

Relationship between Cardiovascular Disease and Mental Health

The link between mental illness and cardiovascular disease has been well established.  While coronary heart disease and mental illness are each among the leading causes of morbidity and mortality worldwide, decades of research has suggested that both may actually cause one another.  There is a large body of literature documenting that people with severe mental illness, as a group, have an increased risk of developing heart disease.  However, there has been little research and data on which mental health conditions in particular pose the highest risk for cardiovascular disease.

About the Study

In this study, researchers assessed whether veterans with depression, anxiety, post-traumatic stress disorder (PTSD), psychosis, and bipolar disorder are at a heightened risk for heart disease, stroke events, and death. This analysis included data from more than 1.6 million veterans ages 45 to 80 who received care within the VA health care system from 2010 to 2014.  Of these veterans, 45 percent of men and 63 percent of women had been diagnosed with a mental health condition.  This study represents the largest-scale assessment of the associations among different psychiatric conditions and major cardiovascular outcomes.

Results of the Study

The study found that when controlling for age, cardiovascular risk factors such as blood pressure and cholesterol, and other mental health conditions and psychiatric medications, both men and women with various mental health diagnoses except PTSD had a higher risk of cardiovascular events and death over five years.  The findings also demonstrated the following:

• For men, depression, anxiety, psychosis, and bipolar disorder were associated with an increased risk of death from cardiovascular disease. Depression, psychosis, and bipolar disorder were also linked to cardiovascular events such as heart attack and stroke.
• For women, depression, psychosis, and bipolar disorder posed a higher cardiovascular disease risk. Additionally, psychosis and bipolar disorder also increased the risk of death.
• A diagnosis of psychosis (e.g. schizophrenia), among both men and women, posed the strongest risk for heart attack, stroke, and death from cardiovascular disease.

Implications of Findings

This research has implications for estimating cardiovascular risk among patients and determining who might benefit from interventions such as cholesterol-lowering medications and blood pressure treatment.  However, the study was not designed to directly assess why veterans with mental health conditions have heightened risk of cardiovascular disease.  Instead, it was conducted to determine if any correlations between certain mental health conditions and cardiovascular risk exist.  Nonetheless, the authors raise the possibility that chronic stress due to mental health problems could play a role.  Overall, when considering a veteran’s health care needs, mental health status (especially for more severe mental illnesses) should be taken into account when calculating cardiovascular disease risk and determining the appropriate treatment options.