2022. Cardiovascular Complications in Diabetic Patients with and without Mental Illness
H Lin, Center for Health Quality, Outcomes, and Economic Research, S Frayne, VA Palo Alto Health Care System, D Miller, Center for Health Quality, Outcomes, and Economic Research, F Wang, Center for Health Quality, Outcomes, and Economic Research, JH Halanych, Center for Health Quality, Outcomes, and Economic Research, K Skinner, Center for Health Quality, Outcomes, and Economic Research, D Berlowitz, Center for Health Quality, Outcomes, and Economic Research

Objectives: Psychiatric comorbidity may impair efforts to provide high quality medical care to veterans with diabetes. The extent  of cardiovascular risk in diabetic patients with comorbid psychiatric illness is not fully understood. We compared cardiovascular complications of diabetes among veterans with and without mental illness.

Methods: We studied 140,889 VA patients with diabetes from the Diabetes Epidemiology Cohort (DEpiC) who had 2+ ICD-9-CM codes for diabetes in FY97-98 or were prescribed antiglycemic medication in FY98 and who participated in  the 1999 Large Health Survey of Veterans.  Using self-report data from the survey, we conducted multivariate analyses modeling history of myocardial infarction (MI) and stroke with depression, post-traumatic stress disorder (PTSD) and schizophrenia. All  models included terms  for age; in a second set we adjusted for age, gender, smoking, hypertension and obesity.

Results: After adjusting for age, depression (N=46,171) was associated with higher risk of MI [OR=1.66 (1.62-1.70)] and stroke [OR=2.02 (1.96-2.08)] . The same was true for PTSD (N=20,207) [OR=1.60 (1.55-1.65) and 1.73 (1.66-1.79), for MI and stroke, respectively] and schizophrenia (N=5,464) [OR=1.07 (1.01-1.13) and 1.40 (1.31-1.51)]. These odds ratios were essentially unchanged after further adjustment for gender, hypertension, smoking and obesity, , except that the association between schizophrenia and MI did not reach statistical significance.

Conclusions: VA diabetic patients with mental illness may be at particularly high risk of cardiovascular complications.  Depression and PTSD contribute independently to cardiovascular risk, even after adjusting for major known risk factors.

Impact: VAs efforts to improve quality of disease management for veterans with diabetes should place special emphasis upon those with comorbid mental illness.  The clustering of complex medical and psychiatric conditions raises the possibility that interdisciplinary approaches to care may be of particular benefit for this at-risk  population.