Ideal Cardiovascular Health in Racially and Ethnically Diverse People with Serious Mental Illness

Background and Purpose:

Cardiovascular disease (CVD) is a primary contributor to premature death among people with serious mental illness (SMI). This study examined the prevalence and correlates of a modified version of the American Heart Association (AHA) metric of ideal cardiovascular health (ICVH) in racially/ethnically diverse people with SMI living in supportive housing.

Methods:

Our study used baseline data from a NIMH-funded trial testing the effectiveness of a peer-led healthy lifestyle intervention for participants with obesity/overweight and SMI in three supportive housing agencies. A total of 314 participants were enrolled and randomized to either usual care or the healthy lifestyle intervention between 2015 and 2018. All participants were included in these analyses. Five ICVH metrics (body mass index [BMI], smoking, diet, physical activity, and blood pressure [BP]) were measured and summed to create a composite ICVH score. Correlates were informed by findings from systematic literature reviews examining ICVH in the general population and studies examining correlates of CVD in people with SMI. Hierarchal regression analysis was used to examine the associations of sample correlates with the composite ICVH score.

Results:

The mean age of participants was 48.7 and 57.3% were male. The most common lifetime mental health diagnoses were depression (75.2%), schizophrenia/schizoaffective disorder (56.7%), and bipolar disorder (46.5%). Approximately 38.5% of participants reported lifetime substance abuse/dependence. The majority (62.7%) were taking an antipsychotic medication. Lifetime physical health diagnoses were high cholesterol (36.3%), diabetes (32.5%), cardiovascular disease (17.2%), and cancer (4.5%). Participants walked on average 318.4 meters during the six-minute walking test (6MWT), a measure of cardiorespiratory fitness (CRF). The prevalence of smoking (64.7%) and obesity (64%) were high, while the prevalence of ideal physical activity (37.6%), healthy diet status (2.2%), and ideal BP (23.6%) were low. The mean ICVH composite score was 3.15 (range 0 – 8). The final hierarchal regression model was significant (p < .05) and accounted for 14.86% of the variance in ICVH scores. After controlling for all covariates, female gender, racial/ethnic minorities, and use of antipsychotic medications were significantly (p < .05) related to low ICVH scores. Higher ICVH scores were associated with lifetime cancer diagnosis and better CRF.

Conclusions and Implications:

In our racially/ethnically diverse sample of people with SMI in supportive house, the prevalence of ICVH was low. Females, racial/ethnic minorities, and those taking antipsychotic medications had lower ICVH scores indicating that these may be important subgroups that could benefit from targeted screening and health interventions. Our finding that racial/ethnic minorities fared worse than non-Hispanic whites adds to the limited knowledge of cardiovascular health (CVH) in minorities with SMI. Moreover, the association between CRF and ICVH scores in our sample highlights the importance of increasing physical activity and reducing sedentary behavior in people with SMI since both are modifiable risk factors that can improve CVH. In order to promote health, and given the strong evidence that each of the ICVH metrics is associated with overall CVH, it is important that clinicians begin making routine the assessment of each of the ICVH metrics.