Targeted Health Dialogues may complement SCORE2 by identifying additional modifiable lifestyle-related risk factors relevant to cardiovascular prevention in patients with mental illness.
The majority of men with mental illness had moderate or high CVD risk according to SCORE2, while only about one-third of women did.
A large proportion of patients with low SCORE2 risk still had several unhealthy modifiable cardiovascular risk factors identified through Targeted Health Dialogues.
Many patients with increased SCORE2 risk also had additional cardiovascular risk factors identified through Targeted Health Dialogues.
SCORE2 does not capture the full range of modifiable lifestyle-related cardiovascular risk factors relevant to patients with mental illness.
Targeted Health Dialogues represent a structured, person-centred approach used in Swedish primary care that assesses lifestyle behaviours influencing CVD risk.
CVD risk factor profiles differed between men and women when assessed across SCORE2 risk levels using THD data.
This research examined whether a comprehensive lifestyle assessment tool called Targeted Health Dialogues (THD) could provide additional information about cardiovascular disease (CVD) risk in people with mental illness, beyond what is captured by a standard risk scoring tool called SCORE2. The study included 120 patients aged 40 to 69 with mental illness attending primary care clinics in Sweden. SCORE2 calculates heart disease risk based on factors like age, sex, cholesterol, blood pressure, and smoking, but does not evaluate other lifestyle factors. THD, by contrast, also assesses body weight, waist measurements, diet, physical activity, alcohol use, sleep quality, and blood sugar levels. The study found that while most men (about 87%) were classified as moderate or high CVD risk by SCORE2, only about a third of women were. Importantly, many patients who scored as 'low risk' on SCORE2 still had multiple unhealthy lifestyle factors — such as high waist-to-hip ratio, high BMI, and physical inactivity — that were only identified through the THD assessment. This suggests that relying solely on SCORE2 may miss important cardiovascular risk information in people with mental illness. This research suggests that using THD alongside SCORE2 in primary care could help identify a wider range of modifiable risk factors in people with mental illness, a group already known to have higher rates of heart disease. The authors call for future studies that follow patients over time or test whether lifestyle counselling guided by THD can actually reduce cardiovascular risk in this population.
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Upload Your LabsMilos-Nymberg V, Glock H, Pikkemaat M, Wolff M, Bolmsjö B, Nymberg P. (2026). Cardiovascular risk assessment with SCORE2 and targeted health dialogues in primary care patients with mental illness.. PloS one. https://doi.org/10.1371/journal.pone.0348365