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People with schizophrenia and other psychotic disorders are more likely to die of heart disease than mentally healthy individuals, a study in US veterans indicates.

While the fact that people with psychosis were more likely to smoke and be inactive accounted for much of the difference, it didn’t explain all of it; it’s likely that the isolating, debilitating nature of the mental illness itself is also a factor, Dr. Amy M. Kilbourne of the VA Ann Arbor Health System in Michigan, the lead author of the study, told Reuters Health.

People with serious mental illness die decades earlier than their mentally healthy peers, Kilbourne and her team note in their report. To understand the role of heart disease in shortening the lifespan of mentally ill individuals, they looked at nearly 150,000 vets who had completed a 1999 survey.

Just 11 percent had never been diagnosed with a mental disorder, while 15.5 percent had schizophrenia, 10 percent had bipolar disorder, 5 percent had psychotic symptoms but hadn’t been diagnosed with schizophrenia, 24 percent had major depression, and 34.5 percent had other types of depression.

Within 8 years, 8 percent of the study participants had died of heart disease. Individuals with psychosis were nearly twice as likely to die of heart disease during follow-up compared to those who’d never been diagnosed with a mental disorder.

People with schizophrenia, depression and bipolar disorder also were at increased risk of dying from heart disease, but for individuals with depression or bipolar illness, behavioral factors such as smoking and lack of physical activity accounted for all of the excess risk.

But even after these factors were taken into account, people with schizophrenia were still 17 percent more likely to die of heart disease, while people with other psychotic disorders were at 30 percent greater risk.

The individuals who had psychotic symptoms — indicating a loss of touch with reality — but who didn’t have schizophrenia may have been suffering from dementia or had experienced episodes of delusions or hallucinations for other reasons, Kilbourne noted.

“Just having an unstable life … because of psychotic symptoms really gets in the way of people living a full life,” the researcher said. “Having symptoms of psychosis really puts people in a vulnerable situation. It’s really difficult for them to navigate a health care system, to talk to a health care provider about what their needs are, to take care of themselves.”

To help people with serious mental illness, Kilbourne added, it’s important to offer them a “medical home,” a place where all their health care needs can be met. This care must address the whole person, she said, not just his or her mental problems, and should also include health behavior change education. The VA is currently implementing all of these approaches in caring for vets with mental illness, the researcher said.

In a Health Behavior News Service release accompanying the study, Dr. Eric Goplerud, director of the Center for Integrated Behavioral Health Policy in Washington, said the issue of cardiovascular disease in this population is “huge.”

“As we look at national health reform, it is absolutely critical that people with mental illness and addictions be included — they are dying of preventable medical conditions,” Goplerud said.

Combining the antacid Prilosec with the popular blood thinner Plavix (clopidogrel) can cut the effectiveness of Plavix by half, putting patients at risk for heart attack or stroke, U.S. health officials said Tuesday.

“These recommendations are based upon recently submitted studies by the manufacturer of clopidogrel [Sanofi-Aventis and Bristol-Myers Squibb],” Mary Ross Southworth, deputy director for safety with the U.S. Food and Drug Administration’s Division of Cardiovascular and Renal Products, said during a morning press conference.

“The results of those studies are to avoid the combination of those two medications,” she said, adding that the tandem should be avoided even if the two drugs are taken hours apart.

Combining the two drugs is common because Plavix can upset the stomach. The FDA said patients taking Plavix can take alternatives to Prilosec, such as Mylanta, Maalox, or Zantac, Southworth said.

Prilosec is in a class of drugs called proton-pump inhibitors (PPIs). Prilosec was singled out because it was the only PPI tested in studies submitted by the manufacturer of Plavix, Southworth said.

However, proton-pump inhibitors similar to Prilosec — such as Aciphex, Nexium, Prevacid and Protonix — should also be avoided when taking Plavix, Southworth said.

Other drugs that may also interact with Plavix, making it less effective include: cimetidine (Tagamet), fluconazole (Diflucan), ketoconazole (Nizoral), voriconazole (Vfend), etravirine, felbamate (Felbatol), fluoxetine (Prozac), fluvoxamine (Luvox), and ticlopidine (Ticlid), according to the FDA.

Results of a study presented Monday at the American Heart Association’s annual meeting in Orlando, Fla., also found that people taking the acid reflux drugs Prilosec or Protonix in combination with blood thinners such as Plavix had a higher risk for death after angioplasty than people who didn’t take the two popular antacids.

In January, Sanofi and Bristol-Myers updated Plavix’s labeling to advise against using it in combination with certain heartburn drugs, the Associated Press reported.

On Tuesday, Sanofi spokeswoman Noelle Boyd said the company had bolstered that language labeling. “We’ve strengthened the label to say that these drugs should be avoided altogether, not just discouraged,” she said.

The good news is that a new report shows the percentage of American adults with high LDL cholesterol, the “bad” kind that clogs arteries, decreased by about one-third between 1999 and 2006.

The bad news is that too many of those who have dangerously high levels of LDL cholesterol don’t know it, said study author Dr. Elena V. Kuklina, an epidemiologist and senior service fellow at the U.S. Centers for Disease Control and Prevention. Her research is published in the Nov. 18 issue of the Journal of the American Medical Association.

“In the group with high LDL cholesterol, 60 percent of these people do not know they have this condition,” Kuklina said. “They are in two major groups — those who have never been screened, and those who have been screened but not diagnosed.”

It is not as easy to test for LDL, rather than total blood cholesterol levels, including “good” HDL, Kuklina said. An LDL test requires fasting for the previous eight hours, “and if you are not prepared for this test, it is not going to be correct,” she said. But testing someone and then not informing that person of a dangerously high LDL cholesterol level is not easy to explain, she said.

While many studies have found that overall cholesterol levels in American adults are decreasing, there has not been much information on LDL levels, Kuklina said. The study she did with colleagues at the CDC used data from consecutive results of the National Health and Nutrition Examination Survey. It found that overall prevalence of high LDL cholesterol levels decreased from 31.5 percent in 1999-2000 to 21.2 percent in 2005-2006.

But there is no single definition of high LDL, the report noted. For persons at high risk of major problems because they have diagnosed heart disease, stroke or other cardiovascular conditions, the desired LDL level is 100 milligrams per deciliter of blood. For those at intermediate risk because they have two or more risk factors, such as diabetes, high blood pressure, smoking or a family history of heart trouble, the desired level is 130. For those at low risk because they have no more than one risk factor, the desired level can be as high as 160.

A troubling finding was that the greatest incidence of dangerously high LDL cholesterol is in the high-risk group. The prevalence of high LDL did decrease in that group, but only from 69.4 percent in the first survey to 58.9 percent in the last survey, the study authors reported.

As for the cause of the overall reduction, “we don’t know why, we can only speculate,” Kuklina said. It could be changes in lifestyle, such as better diet, or it could be more widespread use of cholesterol-lowering medications such as statins, she said.

“But we still have many people we could put on statins,” Kuklina noted.

It’s important to remember that LDL cholesterol is just “one of many risk factors for cardiovascular disease,” said Dr. Thomas A. Gaziano, an assistant professor of medicine at Harvard Medical School and an associate physician at Brigham and Women’s Hospital, and co-author of an accompanying editorial.

Doctors must consider all the risk factors when dealing with cardiovascular disease, Gaziano said. “We recommend simplifying how the risk is calculated,” he said. “Once the risk is determined, therapy should be based on overall risk, not just on cholesterol.”

There are different recommendations about the age at which cholesterol screening should begin, Kuklina noted. The CDC, the National Heart, Lung and Blood Institute and the American Heart Association recommend that screening tests should start at age 20, she said.

“I don’t think it unreasonable to get screened once in the 20s, and then with increasing frequency in the 30s,” Gaziano said.

Surging obesity rates, especially among children, may be putting the brakes on progress made in the past few decades against heart disease, researchers report.

And it doesn’t help that many obese or overweight Americans still consider their weight “normal,” as one study found.

One of several studies on the subject of obesity presented Tuesday at the American Heart Association (AHA) annual meeting in Orlando, Fla., found that adults’ blood pressure and blood sugar levels are continuing to rise, fueled in large part by expanding waistlines.

This is swamping recent heart-health improvements such as lowered blood levels of LDL (”bad”) cholesterol or fewer people smoking, experts said.

Poring over government data between 1988-1994 and 2005-2006, researchers found that adult Americans’ average body mass index (BMI) rose from 26.5 to 28.8 over that time span. To put that in context, a BMI of 25 marks the beginning of overweight, while doctors use a BMI of 30 as the threshold for obesity.

More people did achieve optimal LDL levels (22 percent versus 28 percent) and were non-smokers (rising from 45 percent to 50 percent) during the same time period, but those gains were outweighed by fewer people having good blood pressure (48 percent versus 43 percent) or blood sugar control (falling from 67 percent to 58 percent).

In fact, “many people feel the decline in [heart] risk factors is leveling off and there will be an acceleration of cardiovascular disease,” said AHA spokesman Dr. Roger Blumenthal, professor of medicine in the division of cardiology at Johns Hopkins School of Medicine in Baltimore.

Things don’t bode well for the next generation, either: U.S. Centers for Disease Control and Prevention statistics now put the number of obese children and teens in the United States at about one-third.

“The prevalence of obesity and oversight in the U.S. and all developed countries is on the rise and reaching epidemic proportions among both adults and children,” said Dr. David Crowley, lead author of a study on child obesity and a cardiology fellow at Cincinnati Children’s Hospital. “In the course of the past three decades, the prevalence of obesity has doubled or in some cases tripled across all pediatric age groups.”

Not only have children and teens become heavier, their hearts have become unhealthily thicker, as measured by left ventricular mass (LVM), indicating a higher risk for heart disease down the line.

“Left ventricular mass is a marker of stress on the heart and a predictor of heart attack and stroke,” Crowley explained.

Between the mid-1980s and today, average BMIs in this sample of children went from 18.1 to 19.9, while LVM jumped from 31.4 to 32.7. Males and blacks fared worse than their female and/or white peers.

There were nearly twice as many overweight and obese children in the later period compared to the earlier era: 35 percent versus 20 percent. And the number of children with abnormally thick hearts more than doubled, Crowley reported.

“The obesity epidemic is indeed having adverse effects on the hearts of children compared to two decades ago,” he said. “Today’s children have higher BMI and higher LVM and therefore are at a higher risk of heart attack and stroke. If we do not get a handle on this in this country, if kids continue to get heavier, their hearts will inevitably get thicker and kids will be at higher risk of heart attacks and stroke.”

Simple denial may be a component of this disaster, speculated a third study. It found that a large proportion of obese people believe their body size is normal and that they don’t need to shrink. Some even believe they could safely gain more weight.

Almost one in 10 surveyed said they were okay with the size of their bodies after picking from a series of silhouettes the one they felt best represented their image of themselves.

This same group also thought they were healthy, even though many of them had risk factors for heart disease such as diabetes or high blood pressure.

Ironically, individuals who were actually average or thin thought they were larger than they really were.

“Obesity is not benign,” noted study lead author Dr. Tiffany Powell, a cardiology fellow at the University of Texas Southwestern Medical Center in Dallas. “This underscores the need for us as physicians to understand that we not only need to target those who have misperceptions in clinical settings, but we also need to do work at developing community programs targeting those who avoid the health-care system,” Powell said.

“From our data, it looks like those who have misperceptions of body size are much less likely to be seen by physicians,” she added.

Two other groups of researchers at the AHA meeting presented yet more reasons to lose weight. In one study, obese patients who lost weight saw a healthy normalization of the chambers in the right side of the heart (although it’s unclear if this results in decreased risk for actual heart problems). And in another study, weight-loss surgery reduced the size of enlarged hearts. Enlarged hearts carry with them the risk of heart failure.