Graphical Abstract.

The increased risk of cardiovascular disease associated with severe mental illness (SMI) is multifactorial and driven by complex pathways. Patients with SMI have a high burden of cardiovascular risk factors and disease, and a major challenge in clinical practice is that these patients tend to neglect cardiovascular symptoms, healthcare professionals often overlook and misinterpret cardiovascular signs and symptoms of patients, patients are less likely to receive timely and proper cardiovascular care, and treatment adherence is reduced in these patients. Consequently, patients with SMI develop significantly earlier atherosclerotic cardiovascular disease and therefore require intensive primary prevention strategies that include a more aggressive approach to management of cholesterol levels, blood pressure, and other cardiovascular risk factors.