Treating heart disease starts with identifying those most at risk. Despite strong evidence linking mental disorders to increased cardiovascular risk, most clinical risk calculators still overlook these conditions. Research led by PhD candidate Sara Siddiqi, under the supervision of Dr. Jess Fiedorowicz and Dr. Ian Colman, is working towards developing a new cardiovascular risk calculator that integrates mental disorders to improve prediction, prevention, and care of heart disease.
Considering Mental Health in Heart Disease Risk
To not only treat but prevent disease, physicians must first identify which patients are most at risk. This is often achieved using risk calculators—tools that use a range of factors to estimate a person’s likelihood of developing a specific condition, including heart disease. While many models exist for heart disease, they are not without limitations. Growing evidence shows that a range of mental disorders are linked to an increased risk of heart disease (1,2). Yet mental illness is not routinely included as a variable in heart disease risk prediction tools. Research at the BHI, led by Dr. Jess Fiedorowicz and Sara Siddiqi, is working towards change by demonstrating that considering mental health could improve both risk prediction and patient outcomes in heart disease (3).
Dr. Fiedorowicz is the Head and Chief of the Department of Mental Health at The Ottawa Hospital and a senior scientist in the Neuroscience program at the Ottawa Hospital Research Institute. His work has helped shape a growing body of research linking mental disorders to heart disease risk and outcomes (4–9). His lab’s ongoing work is perfectly centered within the BHI framework, examining how disorders of the brain directly influence the risk and progression of diseases of the heart. With support from the BHI, Dr. Fiedorowicz, Sara Siddiqi, and their team are working to develop and validate a heart disease risk calculator that incorporates mental disorders as key variables. The goal is to improve how risk is measured—and ultimately, how disease is prevented.
“We can better predict risk when unique risk factors are considered, and mental disorders are a strong and unique predictor of risk for heart disease. There are currently disparities in care for those with these conditions and even when care is provided, risk could be underestimated. Treating mental disorders as a risk factor, just like other risk factors for heart disease such as hypertension or diabetes mellitus, can raise awareness and combat stigma, while ensuring we don’t underestimate risk for this group already facing disparities in screening and treatment for heart disease,” says Dr. Fiedorowicz.
Assessing Current Heart Disease Risk Calculators
A first step in the process is understanding and evaluating the heart disease risk calculators that already exist in the field. This work has been led by Sara Siddiqi, a PhD candidate in the Epidemiology program at University of Ottawa and a trainee in Dr. Fiedorowicz’s lab. She is also the trainee representative on the BHI Scientific Council, as well as a member of the BHI IDEAS (Inclusion, Diversity, Equity, Accessibility, and Social Justice) Committee. In her recent scientific article, published in the Journal of the American Heart Association, she systematically reviewed the existing scientific literature describing currently available heart disease risk calculators considering mental disorders to identify key gaps and strengths, helping to inform the development of their own model (3).
In her analysis, Siddiqi and her co-authors identified 31 unique studies that included mental disorders in heart disease risk prediction. Many of these studies found a clear association between mental disorders and heart disease risk. However, many calculators were limited to depression and anxiety as indicators of mental health status, overlooking other important conditions such as schizophrenia, psychosis, and bipolar disorder, which have also been linked to increased cardiovascular risk. This, the authors argue, represents a limitation in existing models and underscores the need to consider mental illness more broadly.
Sara further highlights this point: “Many risk calculators for heart disease consider depression and anxiety, and that is a strength in the models. However, it is also important to consider severe mental illnesses which may increase the risk for heart disease even more.”
Their systematic review also examined the use and impact of social and demographic factors in heart disease risk prediction. While many studies included variables such as sex and socioeconomic status, few accounted for how these factors intersect to influence risk. Incorporating this intersectionality, the authors suggest, will be important for building more accurate and equitable risk prediction models going forward.
Development of a New Heart Disease Risk Tool
Having identified key limitations in existing heart risk calculators, Dr. Fiedorowicz, Sara Siddiqi, and their team are now on to the next phase of research: building their own model. The aim is to develop a more accurate heart disease risk calculator by incorporating a broader range of mental disorders, alongside intersecting factors such as sex, ethnicity, and socioeconomic status.
“Our next steps include addressing the gaps we identified in the literature while developing a prediction model for heart disease that includes mental disorders. We hope this work can create a well-informed, stigma-free, equitable, and accurate prediction model for use in Canadian clinical care,” Sara explains.
To ensure the tool is practical in real-world settings, the researchers will engage primary care providers before and after development to assess its accessibility and usability. Ultimately, the goal is to better identify patients at risk of heart disease. By improving how risk is measured, the team hopes to support earlier intervention, extend life expectancy, and reduce the overall burden of heart disease on the healthcare system.
Why the Brain–Heart Connection Matters
This work highlights the importance of viewing the brain and heart as interconnected systems.
“We’ve known for years that people with depression and other mental health conditions are more likely to develop heart disease, but most risk calculators still treat the brain as if it has nothing to do with the heart,” says Dr. Fiedorowicz. “Brain and heart conditions commonly co-occur and can worsen each other. For instance, depression increases inflammation and stress hormones, which directly affect the heart. If, for example, psychiatrists focus only on mood and cardiologists only on the heart, we miss the opportunity to care for the whole person and underestimate risk. Siloed approaches will not advance the science or provide the care patients need.”
By incorporating a broad range of mental health conditions into heart risk assessment, patients at higher risk may be identified earlier and receive more appropriate care. Ultimately, integrating brain and heart health in this way has the potential to improve patient outcomes and support clinicians in practice, leading to better prevention, treatment, and prognosis.
References
- De Hert M, Detraux J, Vancampfort D. The intriguing relationship between coronary heart disease and mental disorders. Dialogues Clin Neurosci. 2018 Mar 31;20(1):31–40. doi:10.31887/DCNS.2018.20.1/mdehert
- Lambert AM, Parretti HM, Pearce E, Price MJ, Riley M, Ryan R, et al. Temporal trends in associations between severe mental illness and risk of cardiovascular disease: A systematic review and meta-analysis. Dregan A, editor. PLOS Med. 2022 Apr 19;19(4):e1003960. doi:10.1371/journal.pmed.1003960
- Siddiqi S, Haggerty T, Akther A, Rusu S, Blair D, Eccles H, et al. Characteristics of Cardiovascular Disease Prediction Models Considering Mental Disorders: A Systematic Review. J Am Heart Assoc. 2026 May 29;e046964. doi:10.1161/JAHA.125.046964
- Fiedorowicz JG. Depression and Cardiovascular Disease: An Update on How Course of Illness May Influence Risk. Curr Psychiatry Rep. 2014 Oct;16(10):492. doi:10.1007/s11920-014-0492-6
- Fiedorowicz JG, He J, Merikangas KR. The association between mood and anxiety disorders with vascular diseases and risk factors in a nationally representative sample. J Psychosom Res. 2011 Feb;70(2):145–54. doi:10.1016/j.jpsychores.2010.07.010
- Fiedorowicz JG, Solomon DA, Endicott J, Leon AC, Li C, Rice JP, et al. Manic/Hypomanic Symptom Burden and Cardiovascular Mortality in Bipolar Disorder. Psychosom Med. 2009 Jul;71(6):598–606. doi:10.1097/PSY.0b013e3181acee26
- Fiedorowicz JG, Palagummi NM, Forman-Hoffman VL, Miller DD, Haynes WG. Elevated Prevalence of Obesity, Metabolic Syndrome, and Cardiovascular Risk Factors in Bipolar Disorder. Ann Clin Psychiatry. 2008 Aug;20(3):131–7. doi:10.1080/10401230802177722
- Gupta A, Tejpal T, Seo C, Fabiano N, Zhao S, Wong S, et al. Mental Disorders as a Risk Factor of Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. JAMA Psychiatry. 2026 Mar 1;83(3):259. doi:10.1001/jamapsychiatry.2025.4253
- Ortiz A, Sanches M, Abdelhack M, Schwaiger TR, Wainberg M, Tripathy SJ, et al. Sex-specific associations between lifetime diagnosis of bipolar disorder and cardiovascular disease: A cross-sectional analysis of 257,673 participants from the UK Biobank. J Affect Disord. 2022 Dec;319:663–9. doi:10.1016/j.jad.2022.09.048