Cardiometabolic risk prevention opportunity in early schizophrenia

Researchers have found that cardiometabolic risk in patients with schizophrenia is heightened in those with established disease, suggesting a need for early intervention in those presenting with their first episode.

Marc De Hert (UPC KU Leuven campus Kortenberg, Belgium) and colleagues found in their review of the literature that in 702 unmedicated patients with schizophrenia and 1106 in their first episode, the overall prevalence of metabolic syndrome was relatively low, at 9.8% and 9.9%, respectively.

By contrast, the prevalence in 24,892 medicated patients not in their first episode was significantly higher, at 35.3%.

Diabetes was found in only 2.1% of unmedicated patients and 1.3% of first-episode patients, while hyperglycemia (>100 mg/dL) was found in 6.4% and 8.7%, respectively. The corresponding rates of diabetes and hyperglycemia for medicated patients not in their first episode were significantly higher, at 12.8% and 27.8%.

Although the majority of metabolic risk factors were more uncommon in the early stages of schizophrenia than in chronic schizophrenia, at least one in five of the unmedicated and first-episode patients were overweight or had high blood pressure or lipid abnormalities.

Such metabolic complications will develop over time, note the researchers in Schizophrenia Bulletin, "offering an important target for prevention."

The only metabolic factor that was higher in the early rather than the late stages of schizophrenia was smoking, with nearly 47% of those in their first episode current smokers.

The researchers say: "Clinicians should focus on preventing initial cardiometabolic risk because subsequent reduction in this risk is more difficult to achieve, either through behavioural or pharmacologic interventions."

De Hert and colleagues recommend that patients with schizophrenia initially receive treatment with antipsychotics that possess a low risk for metabolic side effects, or be given effective weight loss strategies if prescribing higher-risk medications.

Also, all patients should have their weight and metabolic parameters routinely monitored and a risk profile, including medical and behavioural factors, created that can be used for ongoing monitoring, treatment selection, and management.

"Psychiatrists, physicians, nurses, and other members of the multidisciplinary team can help educate and motivate patients who start with antipsychotic treatment to improve their lifestyle through the use of effective behavioural interventions, including smoking cessation, dietary measures, and exercise," the researchers comment.

"If lifestyle interventions do not succeed preferential use of or switching to a lower-risk medication, or addition of a medication known to reduce weight and/or metabolic abnormalities should be considered."

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