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Cardiovascular risk assessment with SCORE2 and targeted health dialogues in primary care patients with mental illness

Milos-Nymberg, Veronica LU orcid ; Glock, Hanna LU ; Pikkemaat, Miriam LU orcid ; Wolff, Moa LU ; Bolmsjö, Beata Borgström LU and Nymberg, Peter LU orcid (2026) In PLOS ONE 21(5 May).
Abstract

Background Patients with mental illness face a higher risk of cardiovascular disease (CVD), mainly due to unhealthy lifestyle habits. The CVD risk assessment tool Systematic COronary Risk Evaluation 2 (SCORE2) does not assess modifiable lifestyle factors beyond smoking. In Sweden, Targeted Health Dialogues (THD) are used in primary care as a structured, person-centred approach designed to evaluate lifestyle behaviours that influence CVD risk. Unlike SCORE2, the THD assesses a broader set of modifiable lifestyle-related cardiovascular risk factors, including BMI, waist–hip ratio, diet quality, physical activity, alcohol and nicotine use, sleep, and fasting biomarkers such as glucose and lipids. This study explored whether THD can add... (More)

Background Patients with mental illness face a higher risk of cardiovascular disease (CVD), mainly due to unhealthy lifestyle habits. The CVD risk assessment tool Systematic COronary Risk Evaluation 2 (SCORE2) does not assess modifiable lifestyle factors beyond smoking. In Sweden, Targeted Health Dialogues (THD) are used in primary care as a structured, person-centred approach designed to evaluate lifestyle behaviours that influence CVD risk. Unlike SCORE2, the THD assesses a broader set of modifiable lifestyle-related cardiovascular risk factors, including BMI, waist–hip ratio, diet quality, physical activity, alcohol and nicotine use, sleep, and fasting biomarkers such as glucose and lipids. This study explored whether THD can add value in identifying cardiovascular risk factors in patients with mental illness, beyond what is captured by SCORE2. Method This cross-sectional study included 120 patients, aged 40–69, with mental illness in Swedish primary care. CVD risk factors were assessed with a THD. SCORE2 was calculated, and the well-known CVD risk factors according to THD were compared across SCORE2 risk levels in men and women separately. Results Most men (86.5%) and one-third (35.5%) of the women had moderate or high CVD risk according to SCORE2. Many patients with increased SCORE2 risk also had other risk factors identified through THD. A large proportion of both sexes with a low SCORE2 risk had several unhealthy modifiable risk factors (including high WHR, BMI, and physical inactivity). Conclusion In conclusion, Targeted Health Dialogues may complement SCORE2 by identifying additional modifiable lifestyle-related risk factors relevant to cardiovascular prevention in patients with mental illness. Further research, including longitudinal and interventional designs, is warranted to evaluate whether THD-guided lifestyle counselling can reduce cardiovascular risk in this population.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
PLOS ONE
volume
21
issue
5 May
article number
e0348365
publisher
Public Library of Science (PLoS)
external identifiers
  • scopus:105037947570
  • pmid:42081503
ISSN
1932-6203
DOI
10.1371/journal.pone.0348365
project
HEAlth Dialogues for patients with Mental Illness in Primary care
language
English
LU publication?
yes
id
19369cca-23db-4664-b88a-856668f9b951
date added to LUP
2026-07-10 13:41:53
date last changed
2026-08-07 15:52:05
@article{19369cca-23db-4664-b88a-856668f9b951,
  abstract     = {{<p>Background Patients with mental illness face a higher risk of cardiovascular disease (CVD), mainly due to unhealthy lifestyle habits. The CVD risk assessment tool Systematic COronary Risk Evaluation 2 (SCORE2) does not assess modifiable lifestyle factors beyond smoking. In Sweden, Targeted Health Dialogues (THD) are used in primary care as a structured, person-centred approach designed to evaluate lifestyle behaviours that influence CVD risk. Unlike SCORE2, the THD assesses a broader set of modifiable lifestyle-related cardiovascular risk factors, including BMI, waist–hip ratio, diet quality, physical activity, alcohol and nicotine use, sleep, and fasting biomarkers such as glucose and lipids. This study explored whether THD can add value in identifying cardiovascular risk factors in patients with mental illness, beyond what is captured by SCORE2. Method This cross-sectional study included 120 patients, aged 40–69, with mental illness in Swedish primary care. CVD risk factors were assessed with a THD. SCORE2 was calculated, and the well-known CVD risk factors according to THD were compared across SCORE2 risk levels in men and women separately. Results Most men (86.5%) and one-third (35.5%) of the women had moderate or high CVD risk according to SCORE2. Many patients with increased SCORE2 risk also had other risk factors identified through THD. A large proportion of both sexes with a low SCORE2 risk had several unhealthy modifiable risk factors (including high WHR, BMI, and physical inactivity). Conclusion In conclusion, Targeted Health Dialogues may complement SCORE2 by identifying additional modifiable lifestyle-related risk factors relevant to cardiovascular prevention in patients with mental illness. Further research, including longitudinal and interventional designs, is warranted to evaluate whether THD-guided lifestyle counselling can reduce cardiovascular risk in this population.</p>}},
  author       = {{Milos-Nymberg, Veronica and Glock, Hanna and Pikkemaat, Miriam and Wolff, Moa and Bolmsjö, Beata Borgström and Nymberg, Peter}},
  issn         = {{1932-6203}},
  language     = {{eng}},
  number       = {{5 May}},
  publisher    = {{Public Library of Science (PLoS)}},
  series       = {{PLOS ONE}},
  title        = {{Cardiovascular risk assessment with SCORE2 and targeted health dialogues in primary care patients with mental illness}},
  url          = {{http://dx.doi.org/10.1371/journal.pone.0348365}},
  doi          = {{10.1371/journal.pone.0348365}},
  volume       = {{21}},
  year         = {{2026}},
}