A systematic review of interventions to manage cardiovascular disease risk factors in people with severe mental illnesses



Background People with severe mental illnesses (SMI) are at increased risk of developing cardiovascular disease (CVD) and die earlier than the general population. This study evaluated and synthesised evidence from published systematic reviews and randomised controlled trials (RCTs) on the effectiveness of pharmacological and behavioural interventions for reducing modifiable CVD risk factors in people with SMI. Methods We searched the Cochrane Library for existing systematic reviews and the Cochrane Schizophrenia and Cochrane Depression, Anxiety and Neurosis Group Trial Registers for additional RCTs. We searched for interventions to manage: cholesterol, diabetes, hypertension, weight, smoking and alcohol-use. Findings Fifteen systematic reviews and 29 additional RCTs from 11,029 references were included. The synthesised data demonstrated good evidence of effective pharmacological and behavioural interventions for weight management and some evidence that combined pharmacological and behavioural interventions might be more effective than either alone. There was good evidence that pharmacological interventions were effective for smoking cessation, or reducing smoking, and some evidence for behavioral or combined interventions. Three studies reported effective interventions to reduce alcohol misuse and one study reported a positive effect of lifestyle intervention on reducing fasted glucose. No studies were found for interventions specifically targeting cholesterol, diabetes or hypertension in SMI. Interpretation There is evidence that CVD risk attributable to weight and smoking can be managed effectively in SMI, using pharmacological and behavioural approaches and limited evidence on alcohol use and fasted glucose. Future research should determine the effectiveness of interventions to manage cholesterol, diabetes, hypertension and alcohol misuse in this population. Key words: Mental health, Primary health care, Cardiovascular disease prevention Key Messages 1.There is evidence that CVD risk attributable to weight and smoking can be managed effectively in SMI using pharmacological and behavioural approaches 2. There is little or no evidence on interventions to manage cholesterol, diabetes, hypertension and alcohol misuse in SMI. 3.. Future research should determine the effectiveness of interventions to manage cholesterol, diabetes, hypertension and alcohol misuse in this population


Ella Zomer

Monash University

Ella Zomer is Research Fellow at Monash University, Melbourne, Australia. Her research thus far has focused on epidemiological modelling and health economics, predominantly in the prevention of chronic disease such as cardiovascular disease. Ella also has an interest in infectious disease modelling.