Serious Mental Illness and Cardiovascular Risk
Key Messages from the 2025 ESC Consensus
People living with serious mental illness (SMI) face a dramatic health inequity: their life expectancy is reduced by 9–15 years compared to the general population, with cardiovascular disease (CVD) as the main driver of premature mortality. While this has been known for years, clinical guidelines have often failed to address it systematically.
The 2025 European Society of Cardiology (ESC) Consensus, led by Héctor Bueno, represents a milestone. For the first time, a major cardiology guideline explicitly integrates the management of SMI into cardiovascular care, setting structured psychiatry–cardiology collaboration as a standard of care.
🔗 Read the ESC 2025 Consensus (Bueno et al.)
Why it Matters
The 2025 European Society of Cardiology (ESC) Consensus, led by Héctor Bueno, represents a milestone. For the first time, a major cardiology guideline explicitly integrates the management of SMI into cardiovascular care, setting structured psychiatry–cardiology collaboration as a standard of care.
🔗 Read the ESC 2025 Consensus (Bueno et al.)
Why it Matters
- Higher risk: People with SMI have a 2–4 times higher risk of sudden cardiac death and arrhythmias than the general population.
- Disparities: They are less likely to receive cardiovascular diagnostic tests, interventions, and rehabilitation programs.
- Complex factors: Psychotropic medications, lifestyle risks, stigma, and reduced access to care all contribute to this gap.
Key Recommendations for SMI in the 2025 ESC Consensus
- Systematic cardiovascular risk assessment regardless of age, especially before and during antipsychotic treatment.
- Management of modifiable risk factors (smoking, obesity, diabetes, hypertension, dyslipidaemia, sedentary lifestyle).
- Optimising psychiatric treatment: prefer monotherapy when possible, use drugs with lower metabolic risk, monitor interactions and side effects, and support adherence.
- Smoking cessation: integrate behavioural and pharmacological support; this benefits both cardiovascular and psychiatric outcomes.
- Collaboration is essential: the Consensus highlights the role of psycho-cardio teams, where psychiatrists, cardiologists, and general practitioners jointly manage patients.
- Combat stigma: equitable cardiovascular care for people with SMI is a responsibility shared by all healthcare professionals.
Conclusion
The ESC 2025 Consensus marks a turning point: it recognises that improving cardiovascular outcomes in people with SMI requires structured, multidisciplinary collaboration. This is no longer optional but part of best clinical practice.
For psychiatry and cardiology alike, this consensus offers a roadmap: work together, address disparities, and ensure that people with SMI receive the same standard of cardiovascular care as anyone else.
For psychiatry and cardiology alike, this consensus offers a roadmap: work together, address disparities, and ensure that people with SMI receive the same standard of cardiovascular care as anyone else.