Cardiovascular Risk Prediction Models for People With Severe Mental Illness: Results From the Prediction and Management of Cardiovascular Risk in People With Severe Mental Illnesses (PRIMROSE) Research Program
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IMPORTANCE: People with severe mental illness (SMI), including schizophrenia and bipolar disorder, have excess rates of cardiovascular disease (CVD). Risk prediction models validated for the general population may not accurately estimate cardiovascular risk in this group. OBJECTIVE: To develop and validate a risk model exclusive to predicting CVD events in people with SMI incorporating established cardiovascular risk factors and additional variables. DESIGN, SETTING, AND PARTICIPANTS: We used anonymous/deidentified data collected between January 1, 1995, and December 31, 2010, from the Health Improvement Network (THIN) to conduct a primary care, prospective cohort and risk score development study in the United Kingdom. Participants included 38,824 people with a diagnosis of SMI (schizophrenia, bipolar disorder, or other nonorganic psychosis) aged 30 to 90 years. During a median follow-up of 5.6 years, 2324 CVD events (6.0%) occurred. MAIN OUTCOMES AND MEASURES: Ten-year risk of the first cardiovascular event (myocardial infarction, angina pectoris, cerebrovascular accidents, or major coronary surgery). Predictors included age, sex, height, weight, systolic blood pressure, diabetes mellitus, smoking, body mass index (BMI), lipid profile, social deprivation, SMI diagnosis, prescriptions for antidepressants and antipsychotics, and reports of heavy alcohol use. RESULTS: We developed 2 CVD risk prediction models for people with SMI: the PRIMROSE BMI model and the PRIMROSE lipid model. These models mutually excluded lipids and BMI. In terms of discrimination, from cross-validations for men, the PRIMROSE lipid model D statistic was 1.92 (95% CI, 1.80-2.03) and C statistic was 0.80 (95% CI, 0.76-0.83) compared with 1.74 (95% CI, 1.63-1.86) and 0.78 (95% CI, 0.75-0.82) for published Cox Framingham risk scores. The corresponding results in women were 1.87 (95% CI, 1.76-1.98) and 0.79 (95% CI, 0.76-0.82) for the PRIMROSE lipid model and 1.58 (95% CI, 1.48-1.68) and 0.77 (95% CI, 0.73-0.81) for the Cox Framingham model. Discrimination statistics for the PRIMROSE BMI model were comparable to those for the PRIMROSE lipid model. Calibration plots suggested that both PRIMROSE models were superior to the Cox Framingham models. CONCLUSIONS AND RELEVANCE: The PRIMROSE BMI and lipid CVD risk prediction models performed better in SMI compared with models that include only established CVD risk factors. Further work on the clinical effectiveness and cost-effectiveness of the PRIMROSE models is needed to ascertain the best thresholds for offering CVD interventions.
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The surrogate measure lacks validation in a population with schizophrenia.
“A weakness, though, is the lack of validation of the surrogate measure in a population with schizophrenia.”
Research published after the initiation of this trial has questioned the generalizability of cardiovascular risk scores to people with severe mental illness.
“In fact, research published after the initiation of this trial has questioned the generalizability of cardiovascular risk scores to people with severe mental illness 58 .”
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Self-citation
- Authors
- Osborn, D. P. J., Hardoon, S., Omar, R. Z., Holt, R. I. G., King, M., Larsen, J., Marston, L., Morris, R. W., Nazareth, I., Walters, K., & Petersen, I.
- Affiliations
- National Health Service (GB)
- University College London (GB)
- University of Southampton (GB)
- Rethink Mental Illness (GB)
- Corresponding author
- Osborn, David P. J.
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2015-02-01
- Volume
- 72
- Issue
- 2
- Pages
- 143
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC4353842
- OpenAlex
- W2008799821
- Cited by
- 200
- References
- 25
- Citations by year
- 2026: 18 · 2025: 23 · 2024: 13 · 2023: 17 · 2022: 12 · 2021: 33 · 2020: 12 · 2019: 14 · 2018: 15 · 2017: 14 · 2016: 22 · 2015: 7
- FWCI
- 10.94
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion)
- PubMed Central (acceptedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0611-10210, RP-PG-0609-10156)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- cardiovascular risk prediction, severe mental illness, schizophrenia, bipolar disorder, cardiovascular disease, body mass index, lipid profile, myocardial infarction, stroke, risk model validation, primary care cohort, social deprivation, antipsychotic use, alcohol consumption, diabetes mellitus, smoking, sex differences in cardiovascular risk, Health Improvement Network
- MeSH terms
- Adult, Aged, Aged, 80 and over, Bipolar Disorder, Cardiovascular Diseases, Female, United Kingdom, Humans, Male, Middle Aged, Prognosis, Psychotic Disorders, Risk, Schizophrenia, Models, Statistical, Comorbidity, Electronic Health Records
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