BACKGROUND: Individuals with severe mental illness (SMI)-schizophrenia, schizoaffective disorder, and bipolar disorder-are at higher risk for cardiovascular disease (CVD) than the general population. Black Americans are known to have a higher prevalence of cardiovascular risk factors. However, the association of SMI with CVD and its risk factors in this population has not been widely examined. METHODS: The analytic sample included 2305 participants from the African Ancestry-Genomic Psychiatric Cohort enrolled in Brooklyn, New York, between 2016 and 2020. SMI was identified by using the Diagnostic Interview for Psychoses and Affective Disorders. Associations between SMI and CVD and its risk factors, including high body mass index, diabetes, hypertension, and hypercholesterolemia, were evaluated by using logistic regression models adjusted for age, sex, alcohol, and tobacco use. RESULTS: After multivariable adjustment, compared to those without SMI, participants with SMI had significantly higher odds of CVD and CVD risk factors. After adjusting for all CVD risk factors mentioned above, SMI was independently associated with 57% higher odds of CVD (OR=1.57
95% CI, 1.14-2.15). These associations were more pronounced among middle-aged adults (30-49 years), most notably for CVD (OR=5.13
95% CI, 2.45-10.75), hypercholesterolemia (OR=2.88
95% CI, 1.80-4.64), and diabetes (OR=3.08
95% CI, 1.88-5.02). CONCLUSIONS: In this sample, SMI was associated with higher CVD risk even after controlling for other CVD risk factors. There is an urgent need for earlier recognition and treatment of CVD and its risk factors in African American populations with SMI. Targeted clinical and lifestyle interventions in this population are warranted.