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Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis.

Abstract

BACKGROUND

Cardiovascular risk (CVR) has been observed to be higher in patients with severe mental illness (SMI) than in the general population. However, some studies suggest that CVR is not equally increased in different subgroups of SMI. The purposes of this review are to summarise CVR scores of SMI patients and to determine the differences in CVR between patients with different SMIs and between SMI patients and the control-population.

METHODS

MEDLINE (via PubMed) was searched for literature published through August 28, 2014, followed by a snowball search in the Web of Science. Observational and experimental studies that reported CVR assessments in SMI patients using validated tools were included. The risk of bias was reported using STROBE and CONSORT criteria. Pooled continuous data were expressed as standardized mean differences (SMD) with 95% confidence intervals (CI). Two reviewers independently selected studies, extracted data and assessed methodological quality.

RESULTS

A total of 3,608 articles were identified, of which 67 full text papers were assessed for eligibility and 35 were finally included in our review, in which 12,179 psychiatric patients and 225,951 comparative patients had been assessed. The most frequent diagnoses were schizophrenia and related diagnoses (45.7%), depressive disorders (14.7%), SMI (11.4%) and bipolar disorders (8.6%). The most frequent CVR assessment tool used was the Framingham risk score. Subgroups analysis showed a higher CVR in schizophrenia than in depressive disorder or in studies that included patients with multiple psychiatric diagnoses (SMD: 0.63, 0.03, and 0.02, respectively). Six studies were included in the meta-analysis. Total overall CVR did not differ between SMI patients and controls (SMD: 0.35 [95% CI:-0.02 to 0.71], p = 0.06); high heterogeneity was observed (I (2) = 93%; p < 0.001).

CONCLUSIONS

The summary of results from studies that assessed CVR using validated tools in SMI patients did not find sufficient data (except for limited evidence associated with schizophrenia) to permit any clear conclusions about increased CVR in this group of patients compared to the general population. The systematic review is registered in

PROSPERO

CRD42013003898 .

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  • Authors+Show Affiliations

    ,

    Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Universitat Autònoma de Barcelona, Gran Via Corts Catalanes, 587 àtic, 08007, Barcelona, Spain. qfoguet@idiapjgol.org. Department of Medical Sciences, School of Medicine, University of Girona, Emili Grahit, 77, 17071, Girona, Spain. qfoguet@idiapjgol.org.

    ,

    Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Universitat Autònoma de Barcelona, Gran Via Corts Catalanes, 587 àtic, 08007, Barcelona, Spain. Técnica de Salud ICS, Unitat Docent AFiC, Sardenya, 375, Entl., 08025, Barcelona, Spain.

    ,

    Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Universitat Autònoma de Barcelona, Gran Via Corts Catalanes, 587 àtic, 08007, Barcelona, Spain.

    ,

    Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Universitat Autònoma de Barcelona, Gran Via Corts Catalanes, 587 àtic, 08007, Barcelona, Spain. Faculty of Nursing, University of Girona, Emili Grahit, 77, 17071, Girona, Spain.

    ,

    The Westborough Road Health Centre, 258 Westborough Road, Westcliff-on-Sea, SS0 9PT, United Kingdom. Centre of Primary Care and Public Health, Queen Mary University of London, Yvone Carter Building 58 Tuner Street, E1 2AB, London, United Kingdom.

    ,

    The Westborough Road Health Centre, 258 Westborough Road, Westcliff-on-Sea, SS0 9PT, United Kingdom.

    ,

    Departamento de Psiquiatría y Medicina Legal, Instituto de Neuropsiquiatría y Adicciones (INAD), Hospital del Mar Parc de Salut Mar., Universidad Autónoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain.

    ,

    Gimbernat School of Nursing, Universitat Autònoma de Barcelona, Avinguda de la Generalitat, 202-206, Sant Cugat del Vallès, 08174, Barcelona, Spain.

    Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Universitat Autònoma de Barcelona, Gran Via Corts Catalanes, 587 àtic, 08007, Barcelona, Spain.

    Source

    BMC psychiatry 16: 2016 May 12 pg 141

    MeSH

    Cardiovascular Diseases
    Comorbidity
    Female
    Humans
    Mental Disorders
    Risk Assessment
    Risk Factors

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    27176477

    Citation

    Foguet-Boreu, Quintí, et al. "Cardiovascular Risk Assessment in Patients With a Severe Mental Illness: a Systematic Review and Meta-analysis." BMC Psychiatry, vol. 16, 2016, p. 141.
    Foguet-Boreu Q, Fernandez San Martin MI, Flores Mateo G, et al. Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis. BMC Psychiatry. 2016;16:141.
    Foguet-Boreu, Q., Fernandez San Martin, M. I., Flores Mateo, G., Zabaleta Del Olmo, E., Ayerbe García-Morzon, L., Perez-Piñar López, M., ... Violán, C. (2016). Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis. BMC Psychiatry, 16, p. 141. doi:10.1186/s12888-016-0833-6.
    Foguet-Boreu Q, et al. Cardiovascular Risk Assessment in Patients With a Severe Mental Illness: a Systematic Review and Meta-analysis. BMC Psychiatry. 2016 May 12;16:141. PubMed PMID: 27176477.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis. AU - Foguet-Boreu,Quintí, AU - Fernandez San Martin,Maria Isabel, AU - Flores Mateo,Gemma, AU - Zabaleta Del Olmo,Edurne, AU - Ayerbe García-Morzon,Luís, AU - Perez-Piñar López,Maria, AU - Martin-López,Luis Miguel, AU - Montes Hidalgo,Javier, AU - Violán,Concepción, Y1 - 2016/05/12/ PY - 2015/06/29/received PY - 2016/04/25/accepted PY - 2016/5/14/entrez PY - 2016/5/14/pubmed PY - 2016/12/15/medline KW - Bipolar disorder KW - Cardiovascular risk KW - Depressive disorder KW - Schizophrenia KW - Severe mental illness KW - Systematic review SP - 141 EP - 141 JF - BMC psychiatry JO - BMC Psychiatry VL - 16 N2 - BACKGROUND: Cardiovascular risk (CVR) has been observed to be higher in patients with severe mental illness (SMI) than in the general population. However, some studies suggest that CVR is not equally increased in different subgroups of SMI. The purposes of this review are to summarise CVR scores of SMI patients and to determine the differences in CVR between patients with different SMIs and between SMI patients and the control-population. METHODS: MEDLINE (via PubMed) was searched for literature published through August 28, 2014, followed by a snowball search in the Web of Science. Observational and experimental studies that reported CVR assessments in SMI patients using validated tools were included. The risk of bias was reported using STROBE and CONSORT criteria. Pooled continuous data were expressed as standardized mean differences (SMD) with 95% confidence intervals (CI). Two reviewers independently selected studies, extracted data and assessed methodological quality. RESULTS: A total of 3,608 articles were identified, of which 67 full text papers were assessed for eligibility and 35 were finally included in our review, in which 12,179 psychiatric patients and 225,951 comparative patients had been assessed. The most frequent diagnoses were schizophrenia and related diagnoses (45.7%), depressive disorders (14.7%), SMI (11.4%) and bipolar disorders (8.6%). The most frequent CVR assessment tool used was the Framingham risk score. Subgroups analysis showed a higher CVR in schizophrenia than in depressive disorder or in studies that included patients with multiple psychiatric diagnoses (SMD: 0.63, 0.03, and 0.02, respectively). Six studies were included in the meta-analysis. Total overall CVR did not differ between SMI patients and controls (SMD: 0.35 [95% CI:-0.02 to 0.71], p = 0.06); high heterogeneity was observed (I (2) = 93%; p < 0.001). CONCLUSIONS: The summary of results from studies that assessed CVR using validated tools in SMI patients did not find sufficient data (except for limited evidence associated with schizophrenia) to permit any clear conclusions about increased CVR in this group of patients compared to the general population. The systematic review is registered in PROSPERO: CRD42013003898 . SN - 1471-244X UR - https://www.unboundmedicine.com/medline/citation/27176477/full_citation L2 - https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0833-6 DB - PRIME DP - Unbound Medicine ER -