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Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis

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...

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Autores principales: Foguet-Boreu, Quintí, Fernandez San Martin, Maria Isabel, Flores Mateo, Gemma, Zabaleta del Olmo, Edurne, Ayerbe García-Morzon, Luís, Perez-Piñar López, Maria, Martin-López, Luis Miguel, Montes Hidalgo, Javier, Violán, Concepción
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866037/
https://www.ncbi.nlm.nih.gov/pubmed/27176477
http://dx.doi.org/10.1186/s12888-016-0833-6
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author Foguet-Boreu, Quintí
Fernandez San Martin, Maria Isabel
Flores Mateo, Gemma
Zabaleta del Olmo, Edurne
Ayerbe García-Morzon, Luís
Perez-Piñar López, Maria
Martin-López, Luis Miguel
Montes Hidalgo, Javier
Violán, Concepción
author_facet Foguet-Boreu, Quintí
Fernandez San Martin, Maria Isabel
Flores Mateo, Gemma
Zabaleta del Olmo, Edurne
Ayerbe García-Morzon, Luís
Perez-Piñar López, Maria
Martin-López, Luis Miguel
Montes Hidalgo, Javier
Violán, Concepción
author_sort Foguet-Boreu, Quintí
collection PubMed
description 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 PROSPERO: CRD42013003898. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12888-016-0833-6) contains supplementary material, which is available to authorized users.
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spelling pubmed-48660372016-05-14 Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis Foguet-Boreu, Quintí Fernandez San Martin, Maria Isabel Flores Mateo, Gemma Zabaleta del Olmo, Edurne Ayerbe García-Morzon, Luís Perez-Piñar López, Maria Martin-López, Luis Miguel Montes Hidalgo, Javier Violán, Concepción BMC Psychiatry Research Article 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 PROSPERO: CRD42013003898. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12888-016-0833-6) contains supplementary material, which is available to authorized users. BioMed Central 2016-05-12 /pmc/articles/PMC4866037/ /pubmed/27176477 http://dx.doi.org/10.1186/s12888-016-0833-6 Text en © Foguet-Boreu et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Foguet-Boreu, Quintí
Fernandez San Martin, Maria Isabel
Flores Mateo, Gemma
Zabaleta del Olmo, Edurne
Ayerbe García-Morzon, Luís
Perez-Piñar López, Maria
Martin-López, Luis Miguel
Montes Hidalgo, Javier
Violán, Concepción
Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis
title Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis
title_full Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis
title_fullStr Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis
title_full_unstemmed Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis
title_short Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis
title_sort cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866037/
https://www.ncbi.nlm.nih.gov/pubmed/27176477
http://dx.doi.org/10.1186/s12888-016-0833-6
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