Evaluation of cardiovascular risk in adult psychiatric outpatients in Qatar using two risk assessment tools

Abstract

Introduction: Individuals with serious mental illness (SMI) experience premature death, likely due to increased rates of obesity and cardiovascular disease (CVD). This study was conducted to estimate the CVD risk in a cohort of individuals with SMI receiving outpatient psychiatric services in Qatar and to assess contributory CVD risk factors.

Methods: This is a retrospective review of the electronic medical records of a cohort of outpatients with SMI attending a mental health clinic in Doha, Qatar. The CVD risk was estimated using two risk prediction tools: the American Heart Association and the American College of Cardiology (AHA/ACC) risk calculator and the World Health Organization/International Society of Hypertension (WHO/ISH) CVD risk prediction charts for the Eastern Mediterranean region. Descriptive and inferential statistics were used to analyze the demographic and clinical data. Data were analyzed using Statistical Package for the Social Sciences.

Results: Of the 346 eligible patients, 28% (n = 97) had obtainable data for the estimation of their CVD risk using both tools. Approximately one-third of the cohort (33%) were classified as high risk using the AHA/ACC risk calculator, and 13.3% were classified as intermediate to high risk using the WHO/ISH CVD risk prediction charts. Based on the AHA/ACC risk scores, among those with a high CVD risk, almost two-thirds had CVD modifiable risk factors (i.e., smoking, diabetes, dyslipidemia, and hypertension). No statistically significant difference in the CVD risk estimates was observed among individuals with a body mass index of more or lower than 30 kg/m² (p = 0.815).

Conclusion: Based on the AHA/ACC risk calculator, approximately one-third of the study cohort had high CVD risk estimates. The WHO/ISH CVD risk prediction charts appeared to underestimate CVD risk, particularly for those identified as high risk using the AHA/ACC risk calculator. A closer alliance between psychiatrists and primary healthcare professionals to control modifiable cardiovascular risk factors among patients with SMI is necessary.

Keywords: cardiovascular disease; risk assessment; serious mental illness.

Figure 1.

Cardiovascular risk disease risk profile of the cohort of patients with serious mental illness. The number of all SMI samples and BMI < 30 kg/m² or BMI>30 kg/m² with (a) high or low ASCVD risk according to the AHA/ACC risk calculator (n = 97) (b) low and moderate to high ASCVD risk using the WHO/ISH CVD risk prediction charts (n = 97)

Figure 2.

Unadjusted logistic regression analysisForest plot for univariate analysis of the characteristic risks associated with CVD risk. The bars with squares in the middle represent 95% confidence intervals (95% CIs) and odds ratios (ORs). The central vertical solid line indicates the ORs for the null hypothesis Legend: MDD=Major depressive disorder; BPAD=Bipolar and related disorders; BMI = body mass index; SBP = systolic blood pressure; HDL = high density lipoprotein^aMissing data for the ASCVD risk (n = 249)^bMissing data for smoking (n = 150)^cMissing data for body mass index (n = 75).^*Psychotic disorder includes schizophrenia and schizoaffective disorder