Veterans With Psychiatric Diagnosis at Greater Cardiovascular Disease Risk

Study findings published online in Circulation: Cardiovascular Quality and Outcomes suggest that veterans diagnosed with psychosis, bipolar disorder, depression, anxiety, and posttraumatic stress disorder are at an increased risk for cardiovascular disease.

“Although previous studies have demonstrated an association between various mental illnesses and cardio-cerebrovascular disease (CVD) risk, few have compared the strength of association between different mental illnesses and CVD risk,” said lead author Mary C Vance, MD, MSc, Uniformed Services University, and colleagues.

For the study, Dr Vance and colleagues assessed the association of psychiatric diagnoses, including psychosis, bipolar disorder, depression, anxiety, and posttraumatic stress disorder, with major CVD outcomes over 5 years. They used a cohort of military veterans receiving care in the Department of Veteran Affairs for the study. Further, they used multiple logistic regression to examine how the presence of a psychiatric diagnosis at baseline was associated with CVD outcomes over the next 5 years. 

The researchers identified 1.52 million men and 94,000 women who met inclusion criteria. According to the findings, among men, depression, psychosis, and bipolar disorder were predictive of both CVD events and CVD mortality, with psychosis having the largest effect size (eg, adjusted odds ratio, 1.48; CI, 1.41-1.56; P<.001 for psychosis and CVD mortality). Comparatively among women, only psychosis and bipolar disorder were predictive of both CVD events and CVD mortality, with psychosis having the largest effect size (eg, adjusted odds ratio, 1.97; CI, 1.52-2.57; P<.001 for psychosis and CVD mortality). The researchers noted that anxiety was linked to CVD mortality in men, and depression linked to CVD events in women.  

“Consistent with the hypothesis that chronic stress leads to greater CVD risk, multiple mental illnesses were associated with an increased risk of CVD outcomes, with more severe mental illnesses (eg, primary psychotic disorders) having the largest effect sizes even after controlling for other psychiatric diagnoses, conventional CVD risk factors, and psychotropic medication use,” concluded Dr Vance and colleagues.—Julie Gould