Researchers have discovered a link between depression, psychosis and bipolar disorder in veterans – and a heightened risk of stroke, heart attack and death from cardiovascular disease.

The connection between mental illness and cardiovascular disease is well established but little research exists on which mental health conditions pose the highest risk.

In this study, researchers assessed veterans at risk for major heart disease and stroke events and death associated with depression, anxiety, PTSD, psychosis and bipolar disorder.

The analysis included data from more than 1.6 million veterans ages 45 to 80 who received care in the US Department of Veterans Affairs healthcare system from 2010-2014.

Around 45 per cent of the men and 63 per cent of the women had been diagnosed with a mental health disorder.

When controlling for age, cardiovascular risk factors such as blood pressure and cholesterol, other mental health conditions and psychiatric medications, both men and women with various mental health diagnoses except post-traumatic stress disorder had a higher risk of cardiovascular events and death over five years.

In particular, among men, depression, anxiety, psychosis and bipolar disorder were associated with an increased risk of death from cardiovascular disease. And, depression, psychosis and bipolar disorder were also linked to cardiovascular events such as heart attack and stroke.

Among women, depression, psychosis and bipolar disorder posed a higher cardiovascular disease risk. Psychosis and bipolar disorder also increased the risk of death.

A diagnosis of psychosis, such as schizophrenia, among both men and women posed the strongest risk for heart attack, stroke and death from cardiovascular disease.

A PTSD diagnosis among men in the study was associated with a lower risk of cardiovascular disease compared to the study population as a whole. This finding differed from some previous studies.

According to the study authors, this is the largest-scale assessment of the associations among different psychiatric conditions and major cardiovascular outcomes. Researchers state that these findings have implications for estimating cardiovascular risk among patients and determining who might benefit from interventions such as cholesterol-lowering medications and blood pressure treatment.

This study was not designed to assess why veterans with mental health conditions have heightened cardiovascular risk, although the authors raise the possibility that chronic stress due to mental health problems could play a role.

“The bottom line is that when considering a veteran’s health care needs, mental health status, especially for more severe mental illnesses, should be taken into consideration when calculating cardiovascular disease risk and considering the appropriate treatment options,” said Mary C. Vance, an employee of the Henry M. Jackson Foundation working as assistant professor of psychiatry at the Uniformed Services University School of Medicine and lead author of the study.

The researchers say that although their study population was large, results could differ in a population outside of the Veterans Affairs health system.

The study was published in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.