title: 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
  CRD42013003898 .
authors.affiliation: 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.
authors.forename: Quintí
authors.initials: Q
authors.lastname: Foguet-Boreu
authors.affiliation: 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.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Fernandez San Martin
authors.affiliation: 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.
authors.forename: Gemma
authors.initials: G
authors.lastname: Flores Mateo
authors.affiliation: 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.
authors.forename: Edurne
authors.initials: E
authors.lastname: Zabaleta Del Olmo
authors.affiliation: 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.
authors.forename: Luís
authors.initials: L
authors.lastname: Ayerbe García-Morzon
authors.affiliation: The Westborough Road Health Centre, 258 Westborough Road, Westcliff-on-Sea, SS0 9PT, United Kingdom.
authors.forename: Maria
authors.initials: M
authors.lastname: Perez-Piñar López
authors.affiliation: 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.
authors.forename: Luis Miguel
authors.initials: LM
authors.lastname: Martin-López
authors.affiliation: Gimbernat School of Nursing, Universitat Autònoma de Barcelona, Avinguda de la Generalitat, 202-206, Sant Cugat del Vallès, 08174, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Montes Hidalgo
authors.affiliation: 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.
authors.forename: Concepción
authors.initials: C
authors.lastname: Violán
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D018570:Risk Assessment; D012307:Risk Factors
keywords: Bipolar disorder; Cardiovascular risk; Depressive disorder; Schizophrenia; Severe mental illness; Systematic review