Maladie cardiovasculaire et diabète chez les personnes atteintes d'une maladie mentale sévère

People with severe mental illnesses, such as schizophrenia, depression or bipolar disorder, have worse physical health and reduced life expectancy compared to the general population. The excess cardiovascular mortality associated with schizophrenia and bipolar disorder is attributed in part to an increased risk of the modifiable coronary heart disease risk factors: obesity, smoking, diabetes, hypertension and dyslipidemia. Antipsychotic medication and possibly other psychotropic medication, like antidepressants, can induce weight gain or worsen other metabolic cardiovascular risk factors. Patients may have limited access to general healthcare with less opportunity for cardiovascular risk screening and prevention than would be expected in a non-psychiatric population. The European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC) recently published a statement with the aim of improving the care of patients suffering from severe mental illness. This first paper summarizes the epidemiological data of coronary heart disease and stroke in this special population as well as the potential cardiometabolic consequences of psychotropic medications. A second article will explain how to evaluate the cardiovascular risk and give recommendations concerning the appropriate management of risk factors and diabetes in the psychiatric population.