Study investigates new intervention to reduce cardiovascular disease risk factors for people with severe mental illnesses

A study led by Professor David Osborn in the UCL Division of Psychiatry (DoP) has been published in the Lancet Psychiatry this month (February 2018).

The study developed a new intervention to reduce cardiovascular disease risk factors for people with severe mental illnesses (SMI) and tested this new intervention against routine GP Practice care. 

People with SMI, such as schizophrenia, bipolar disorder, or psychosis, have a well-established increased risk of morbidity and mortality from cardiovascular disease. The paper has generated interest because although it showed similar cardiovascular outcomes in both trial arms, the new intervention was associated with fewer psychiatric admissions and therefore lower costs.

The study was funded by a National Institute for Health Research Programme Grant for Applied Research (NIHR PGfAR) and included researchers from the DoP, UCL Centre for Behaviour Change (Division of Psychology and Language Sciences) and UCL Departments of Primary Care and Population Health, Allied Health Research and Statistical Science. Other collaborators included University of Southampton, Kings College London, Imperial College London, University of Bristol, Camden and Islington NHS Foundation Trust and The McPin Foundation.

The researchers ran a cluster randomised controlled trial involving 327 participants across 76 general practices in England. The participants, aged 30-75 years old, had SMI, a raised cholesterol concentration and one or more modifiable cardiovascular disease risk factors. Half of general practices, including 155 patients, were randomly assigned to the Primrose intervention and the other half, including 172 patients, to treatment as usual.

Participants in the Primrose group had up to 12 appointments over the course of six months from a trained primary care professional. They received manualised interventions for cardiovascular disease prevention, including adhering to statins; improving diet; increasing physical activity; quitting smoking; or reducing alcohol. The treatment-as-usual patients received only feedback on screening results and usual care from their GP practice.

Researchers found that total cholesterol concentration at 12 months went down in both the intervention and routine care group and did not differ between the two groups. The study's authors state that this finding could be ascribed to the cluster design; good care in the treatment as usual group; short duration of the intervention; or low prescribing rates of statins.

They also found a reduction in psychiatric admissions and lower service costs in the Primrose group. However, they cannot conclude that the primary care intervention is more effective than routine care in reducing cardiovascular disease risk.

Alexandra Burton, Primrose programme manager at UCL Psychiatry, explains that people with SMI are still experiencing an increased risk of morbidity and mortality from cardiovascular disease compared to the general population, so there is a "vital need" to find and offer effective treatments.

Related

• Full paper in Lancet Psychiatry, 'Clinical and cost-effectiveness of an intervention for reducing cholesterol and cardiovascular risk for people with severe mental illness in English primary care: a cluster randomised controlled trial'
• Lancet Psychiatry Podcast: Niall Boyce and David Osborn discuss improving cardiovascular health for people with severe mental illnesses.
• UCL Primrose study
• UCL Division of Psychiatry