title: Excess heart-disease-related mortality in a national study of patients with mental disorders: identifying modifiable risk factors.
abstract: OBJECTIVE
  People with mental disorders are estimated to die 25 years younger than the general population, and heart disease (HD) is a major contributor to their mortality. We assessed whether Veterans Affairs (VA) health system patients with mental disorders were more likely to die from HD than patients without these disorders, and whether modifiable factors may explain differential mortality risks.
  
  
  METHODS
  Subjects included VA patients who completed the 1999 Large Health Survey of Veteran Enrollees (LHSV) and were either diagnosed with schizophrenia, bipolar disorder, other psychotic disorders, major depressive disorder or other depression diagnosis or diagnosed with none of these disorders. LHSV data on patient sociodemographic, clinical and behavioral factors (e.g., physical activity, smoking) were linked to mortality data from the National Death Index of the Centers for Disease Control and Prevention. Hierarchical multivariable Cox proportional hazards models were used to assess 8-year HD-related mortality risk by diagnosis, adding patient sociodemographic, clinical and behavioral factors.
  
  
  RESULTS
  Of 147,193 respondents, 11,809 (8%) died from HD. After controlling for sociodemographic and clinical factors, we found that those with schizophrenia [hazard ratio (HR)=1.25; 95% confidence interval (95% CI): 1.15-1.36; P<.001] or other psychotic disorders (HR=1.41; 95% CI: 1.27-1.55; P<.001) were more likely to die from HD than those without mental disorders. Controlling for behavioral factors diminished, but did not eliminate, the impact of psychosis on mortality. Smoking (HR=1.32; 95% CI: 1.26-1.39; P<.001) and inadequate physical activity (HR=1.66; 95% CI: 1.59-1.74; P<.001) were also associated with HD-related mortality.
  
  
  CONCLUSIONS
  Patients with psychosis were more likely to die from HD. For reduction of HD-related mortality, early interventions that promote smoking cessation and physical activity among veterans with psychotic disorders are warranted.
authors.affiliation: VA Ann Arbor HSR&D Center of Excellence and National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI 48105, USA. amykilbo@umich.edu
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Morden
authors.forename: Karen
authors.initials: K
authors.lastname: Austin
authors.forename: Mark
authors.initials: M
authors.lastname: Ilgen
authors.forename: John F
authors.initials: JF
authors.lastname: McCarthy
authors.forename: Gregory
authors.initials: G
authors.lastname: Dalack
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
mesh_terms: D000367:Age Factors; D000368:Aged; D001714:Bipolar Disorder / Q000401:mortality; D002423:Cause of Death; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000401:mortality; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006331:Heart Diseases / Q000401:mortality*; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008019:Life Style; D008297:Male; D001523:Mental Disorders / Q000401:mortality*; D008875:Middle Aged; D016016:Proportional Hazards Models; D011618:Psychotic Disorders / Q000401:mortality; D012307:Risk Factors; D012559:Schizophrenia / Q000401:mortality; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*