Today, mental disorders like schizophrenia, bipolar disorder and severe depression are a major cause of disability in the world that lead to substantial human suffering and severely impair the quality of life for both patients and their families. In addition, the total costs of this disease group are large, and in fact larger than the combined costs of all cancer treatments. Mental disorders are therefore a major public health issue.
Is there a link between cardiovascular disease and mental disorders?
An important aspect of mental disorders is the increased mortality of patients. Researchers at NORMENT have worked extensively on these issues in recent years 1-6. On average patients with mental disorders live 15-20 years shorter than the general population. This is both due to unnatural causes such as suicides or accidents, and natural causes, where cardiovascular disease is most important. Studies show that patients with mental disorders are twice as likely to succumb from cardiovascular disease. Some of this mortality can be explained by accumulation of risk factors such as smoking, poor diet, diabetes, unhealthy blood lipids and obesity. Although the increased risk for these conditions has been known for a long time, it has been difficult to prevent and treat cardiovascular disease in patients with mental disorders. New evidence indicates that part of the increased incidence for cardiovascular disease in patients with mental disorders is connected with their genetic material and is coded in their DNA.
NORMENT leads new initiative
Researchers at NORMENT now want to find out more about how cardiovascular disease is associated with mental disorders. We have together with other European research groups found gene variants among patients with mental disorders that are associated with increased risk for cardiovascular disease. To understand more about how such gene variants can increase the incidence of cardiovascular disease in patients with mental disorders, it is necessary to have a more detailed mapping of the DNA. Therefore NORMENT has initiated several national and European collaborative projects, aiming to utilize information from the establishment of a common database. The database will contain information about environmental factors and DNA gene variants that will provide new knowledge about the overlap in causal factors between mental disorders and cardiovascular disease. The plans are to include data from a large number of people from Scandinavia making it easier to extract knowledge from the database.
To perform the analysis we will utilize the latest developments in analytical methods to map the genome of patients with mental disorders. This analysis will be performed in collaboration with researchers in Iceland. Using this method, scientists have discovered genetic variants among Icelanders that increase the risk of schizophrenia, other brain disorders as well as cardiovascular disease risk factors. The results are published in prestigious scientific journals like Nature Genetics and Circulation. We wish to expand these findings to a European setting and test the methodology in patients from other European countries. The project will allow researchers to detect several types of gene variants which have not been possible using previous methods. This applies both to gene variants that increase the risk of disease, and how these interact with environmental factors.
Large societal benefits, but important ethical challenges must be solved
The initiative could have major health benefits. By uncovering gene variants that protect against or increase the risk of cardiovascular disease in mental disorders, our understanding of the mechanisms behind these diseases will improve. This information could lead to the development of new diagnostic tools that make it easier to determine which individuals are at increased risk for disease. It will also provide researchers with important knowledge for the development of new and better medicines with fewer side effects that are tailored specifically for different (or individual) patients. We hope that the project will lead to better prevention and treatment of cardiovascular disease in people with mental disorders. This could improve the life prospects for a large group of people and reduce the significant societal costs associated with this patient group.
The plans also include ethical aspects and involvement of user groups. We will establish a dialogue with users and families about how scientists should handle information about genetic variants. This is an important ethical and political issue that must be resolved for a number of diseases where genetic risk factors are discovered. New advances in genetic technology make it possible to detect gene variants before such diseases manifest clinical symptoms. Some of these variants may contribute to new treatment strategies, such as prophylactic treatment at an earlier stage than has previously been possible. This could be important for the treatment of people suffering from serious disorders, and lead to significant savings in public health costs.