A 2026 cross-sectional study of 120 Swedish patients with mental illness found that Targeted Health Dialogues identified additional heart disease risk factors—including poor diet, lack of exercise, and excess belly fat—that a standard screening tool called SCORE2 missed. According to Gram Research analysis, while 86.5% of men and 35.5% of women showed moderate-to-high risk on SCORE2, many patients with low SCORE2 scores had multiple unhealthy lifestyle factors, suggesting that combining both assessment methods provides a more complete picture of cardiovascular risk in people with mental illness.
People with mental illness have higher rates of heart disease, often due to unhealthy lifestyle habits. Researchers in Sweden tested whether a conversation-based health assessment tool called Targeted Health Dialogues (THD) could catch more heart disease risk factors than a standard screening tool called SCORE2. In a study of 120 patients with mental illness, THD identified additional lifestyle problems—like poor diet, lack of exercise, and excess belly fat—that SCORE2 missed. According to Gram Research analysis, this suggests that combining both tools could help doctors better protect patients with mental illness from heart disease.
Key Statistics
A 2026 cross-sectional study of 120 patients with mental illness in Swedish primary care found that 86.5% of men and 35.5% of women were classified as having moderate or high cardiovascular disease risk according to SCORE2 screening.
Research published in PLOS One in 2026 showed that a large proportion of patients with low cardiovascular risk on SCORE2 had multiple unhealthy modifiable risk factors identified through Targeted Health Dialogues, including high waist-to-hip ratio, elevated BMI, and physical inactivity.
A 2026 study of 120 patients with mental illness found that Targeted Health Dialogues identified additional cardiovascular risk factors beyond what SCORE2 captured, including diet quality, sleep patterns, and detailed body composition measurements.
The Quick Take
- What they studied: Whether a personalized health conversation tool (THD) could identify more heart disease risk factors than a standard screening test (SCORE2) in people with mental illness.
- Who participated: 120 Swedish patients aged 40-69 with mental illness receiving care at primary care clinics. The group included both men and women with various mental health conditions.
- Key finding: While SCORE2 flagged 86.5% of men and 35.5% of women as having moderate-to-high heart disease risk, THD found that many patients with ’low risk’ on SCORE2 actually had multiple unhealthy lifestyle factors like high belly fat, obesity, and physical inactivity.
- What it means for you: If you have mental illness, your doctor should use both screening methods to get a complete picture of your heart health. This could help catch problems earlier and guide better lifestyle advice. However, more research is needed to prove this approach actually prevents heart disease.
The Research Details
This was a cross-sectional study, which means researchers looked at 120 patients at one point in time rather than following them over months or years. Each patient completed a Targeted Health Dialogue—essentially a structured conversation with a healthcare provider about their lifestyle habits. The conversation covered diet quality, exercise, sleep, alcohol and tobacco use, weight, and belly fat measurements. Researchers then calculated each patient’s heart disease risk using SCORE2, a standard tool that mainly looks at age, sex, blood pressure, cholesterol, and smoking. Finally, they compared what SCORE2 said about risk versus what THD revealed about lifestyle factors.
The THD approach is more comprehensive than SCORE2 because it digs deeper into modifiable lifestyle factors—things people can actually change. SCORE2 is designed to predict heart attack and stroke risk but doesn’t thoroughly assess diet, exercise, sleep quality, or body shape patterns. THD was developed in Sweden specifically to have person-centered conversations that help identify these changeable risk factors.
People with mental illness face a double challenge: their conditions often make healthy living harder (depression can reduce motivation to exercise, for example), and they’re at higher risk for heart disease. Using only SCORE2 might miss important lifestyle problems that could be addressed through counseling and support. A more complete assessment could help doctors provide better, more targeted advice to prevent heart disease in this vulnerable population.
This study has both strengths and limitations. The strength is that it used a real-world sample of patients with mental illness in actual primary care settings, making results relevant to everyday practice. The limitation is that it’s a snapshot in time with only 120 people—a relatively small group. The study doesn’t prove that using THD actually prevents heart disease, only that it identifies more risk factors. The researchers themselves note that longer-term studies are needed to show whether THD-guided counseling actually reduces heart disease risk over time.
What the Results Show
The study revealed a significant gap between what SCORE2 detected and what THD uncovered. Among men, 86.5% were classified as having moderate or high heart disease risk by SCORE2, while only about one-third of women fell into these higher-risk categories. However, the more detailed THD assessment found that many patients classified as ’low risk’ by SCORE2 actually had multiple unhealthy lifestyle factors.
Specifically, a large proportion of both men and women with low SCORE2 risk scores had concerning findings on THD, including high waist-to-hip ratios (excess belly fat), elevated BMI (obesity), and physical inactivity. These are all modifiable risk factors—meaning people can change them through lifestyle adjustments. Additionally, patients who already had high SCORE2 risk scores often had even more lifestyle-related risk factors identified through the THD conversation.
The findings suggest that SCORE2 and THD capture different aspects of heart disease risk. SCORE2 focuses on biological markers like cholesterol and blood pressure that predict immediate risk, while THD identifies lifestyle patterns that contribute to long-term heart disease development. Together, they provide a more complete picture of a patient’s cardiovascular health.
The study noted that the pattern of risk differed between men and women. Men were more likely to be flagged as high-risk by SCORE2, but both sexes showed the pattern of having lifestyle risk factors despite low SCORE2 scores. This suggests that gender-specific approaches to heart disease prevention might be important for people with mental illness. The research also highlighted that unhealthy lifestyle factors—poor diet, lack of exercise, excess weight, and poor sleep—are particularly common in this population, likely because mental illness can make maintaining healthy habits more difficult.
This research builds on existing knowledge that people with mental illness have higher heart disease rates. Previous studies have shown this is partly due to lifestyle factors and partly due to medications used to treat mental illness. This study adds to that understanding by showing that standard heart disease screening tools may not catch all the lifestyle problems that increase risk in this population. The finding that THD identifies additional risk factors aligns with growing recognition in medicine that personalized, conversation-based assessments can reveal important health information that standardized tests might miss.
The study has several important limitations. First, it’s a snapshot—researchers looked at patients at one moment in time, not over months or years, so they can’t determine whether identifying these risk factors actually leads to better health outcomes. Second, the sample size of 120 is relatively small, which limits how much the findings can be generalized to all people with mental illness. Third, the study doesn’t prove that using THD actually prevents heart disease; it only shows that THD identifies more risk factors. Finally, the study was conducted in Sweden, where healthcare systems and patient populations may differ from other countries, so results might not apply everywhere.
The Bottom Line
For patients with mental illness: Ask your doctor to assess your heart disease risk using multiple methods, not just a single screening test. Have conversations about your lifestyle habits—diet, exercise, sleep, weight, and stress. Work with your healthcare team to set realistic goals for lifestyle changes. For healthcare providers: Consider using THD or similar conversation-based assessments alongside SCORE2 when evaluating heart disease risk in patients with mental illness. This more comprehensive approach may help identify patients who need lifestyle counseling. Confidence level: Moderate. The evidence supports this approach, but more research is needed to prove it prevents heart disease.
This research is most relevant to people with mental illness (depression, anxiety, bipolar disorder, schizophrenia, etc.) who are 40-69 years old. It’s also important for primary care doctors, psychiatrists, and mental health professionals who work with these patients. People without mental illness may benefit from similar comprehensive lifestyle assessments, but this study specifically addresses the unique challenges of the mental illness population. People under 40 or over 70 should discuss with their doctors whether these findings apply to them.
Lifestyle changes take time to show benefits for heart health. Most research suggests that meaningful improvements in heart disease risk factors take 3-6 months of consistent effort. However, some benefits—like improved mood and energy from increased exercise—may appear within weeks. Long-term heart disease prevention requires sustained lifestyle changes over years, not just months.
Frequently Asked Questions
Why do people with mental illness have higher heart disease risk?
People with mental illness often have unhealthy lifestyle habits like poor diet, lack of exercise, and irregular sleep. Mental illness can reduce motivation for healthy behaviors. Additionally, some psychiatric medications may increase heart disease risk. This combination makes comprehensive risk assessment especially important.
What is the difference between SCORE2 and Targeted Health Dialogues?
SCORE2 is a quick screening tool that predicts heart attack and stroke risk using age, sex, blood pressure, and cholesterol. Targeted Health Dialogues are structured conversations that assess modifiable lifestyle factors like diet, exercise, sleep, weight, and alcohol use—things people can actually change to reduce risk.
Can identifying more risk factors actually prevent heart disease?
This study shows that THD identifies more risk factors than SCORE2, but doesn’t yet prove that addressing these factors prevents heart disease. Researchers say longer-term studies are needed to confirm that THD-guided lifestyle counseling actually reduces heart disease in people with mental illness.
Should I ask my doctor to use both SCORE2 and health dialogues?
Yes. This research suggests using both tools together provides a more complete picture of your heart disease risk, especially if you have mental illness. Ask your doctor about comprehensive lifestyle assessment alongside standard screening tests to identify all modifiable risk factors.
How long does it take to see heart health improvements from lifestyle changes?
Some benefits like improved energy and mood appear within weeks of increased exercise. However, meaningful improvements in heart disease risk factors typically take 3-6 months of consistent lifestyle changes. Long-term heart disease prevention requires sustained healthy habits over years.
Want to Apply This Research?
- Track weekly physical activity minutes, daily diet quality (using a simple 1-5 rating), waist circumference monthly, and sleep hours nightly. Set a goal of 150 minutes of moderate activity per week and 7-9 hours of sleep per night.
- Use the app to schedule weekly ‘health dialogue’ check-ins with yourself or your healthcare provider. Answer simple questions about your lifestyle each week: Did I exercise? How was my diet? Did I sleep well? This mirrors the THD approach and helps identify patterns.
- Create a monthly dashboard showing trends in activity, diet quality, weight, and sleep. Share this with your doctor at regular visits to track progress and adjust lifestyle goals. Set reminders for preventive health appointments every 3-6 months.
This research describes a screening study and does not establish causation or prove that any specific intervention prevents heart disease. The findings are based on a single cross-sectional study of 120 patients in Sweden and may not apply to all populations. If you have mental illness and concerns about heart disease risk, consult with your primary care doctor or cardiologist for personalized assessment and recommendations. Do not use this information to self-diagnose or self-treat cardiovascular conditions. Any lifestyle changes should be discussed with your healthcare provider, especially if you take psychiatric medications or have existing health conditions.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.