Cardiovascular Disease responsible for shorter life expectancy in people with mental illness

Blog Post by David Gardner, Professor of Psychiatry, Dalhousie University

People living with a major mental illness have a quite notable shorter life expectancy, and the primary reason for this is surprising to some. The risk of death due to suicide is about 15-30 times greater in people with schizophrenia, bipolar disorder, and depression compared to the general population. However, suicide, a rare event, is not the leading driver of excess death or shortened life expectancy. It is cardiovascular disease.

The risk for death due to cardiovascular disease is about double in our patients and, considering its prevalence, is the leading driver of excess death. So, what is contributing to this and what can be done about it? These are the obvious questions. Unfortunately the answers are not so obvious. At a seminar several years ago Professor Mary Seeman of the University of Toronto proposed the following as likely contributory factors: vulnerability genes, smoking, obesity, diet, sedentary lifestyle, diabetes, stress, polysubstance abuse, poverty, poor living conditions, isolation, access to medical care, quality of medical care, and antipsychotic medications. A quick review of this list indicates that most factors are remediable, at least theoretically. Michael Teehan and I developed Antipsychotics and Their Side Effects as a resource and tool to help clinicians address at least one, and possibly several, of these contributory factors. The book compares and contrasts the antipsychotics in terms of their side effects, helping clinicians select a treatment that is most suitable for their patient, and provides clear guidance on what, when, and how to monitor patients for the myriad of antipsychotic-induced side effects. We are hoping that improved, more routine monitoring will lead to better preventive care of patients with mental illness taking antipsychotics (and the ones who are not).

David Gardner is a co-author of Antipsychotics and Their Side Effects, published by Cambridge University Press.