Association between psychiatric comorbidities and the pharmacological secondary prevention of ischemic heart disease and cerebrovascular disease - an analysis of real-world health insurance prescription data in Germany.

BACKGROUND: Individuals with mental disorders face substantially reduced life expectancy, with cardiovascular disease (CVD) as the leading cause of premature death, likely due to a complex interplay of multiple factors. Prior studies examining whether patients with comorbid mental illness receive guideline-concordant pharmacological secondary prevention of ischemic heart disease (IHD) and cerebrovascular disease (CeVD) at rates comparable to those without psychiatric diagnoses are few and yielded inconsistent findings.

METHODS: We conducted a retrospective cross-sectional analysis of statutory health insurance data for 2019-2022 (n = 238,616 adults with IHD or CeVD). Secondary prevention was defined as concurrent prescription of a lipid-modifying agent and an antiplatelet therapy or anticoagulant. Propensity score matching combined with logistic regression was used to estimate adjusted odds ratios (ORs) across all ICD-10 F-chapters (F0-F9) and for severe mental illness (SMI).

RESULTS: Patients with any mental disorder had significantly higher odds of receiving secondary prevention for IHD (OR 1.18) and CeVD (OR 1.17) than those without. SMI was associated with even higher odds (IHD: OR 1.36; CeVD: OR 1.32). Diagnosis-specific subgroup analysis yielded no substantial differences between different mental disorders.

CONCLUSION: In general, prescription rates of pharmacological secondary prevention were higher in patients with comorbid mental disorders compared to patients without mental comorbidity. Factors other than pharmacological undertreatment - such as lifestyle-related prevention and physical health monitoring - may play a more central role in addressing the excess cardiovascular mortality burden in individuals with mental illness.