Cardiometabolic health intervention urged for schizophrenia patients

By Eleanor McDermid, Senior medwireNews Reporter

Research shows high cardiometabolic risk, particularly increased dyslipidaemia and smoking, but little related medical treatment in patients with first-episode schizophrenia.

The study authors say that their findings “highlight major opportunities for improvement in health care planning and delivery for people with schizophrenia.”

Christoph Correll (The Zucker Hillside Hospital, Glen Oaks, New York, USA) and co-workers found that some indicators of poor metabolic health related to the duration of psychotic illness, while others correlated with the duration of antipsychotic treatment.

The 394 patients were aged 24 years, on average, and had a prevalence of overweight and obesity that, at 48.3%, was equivalent to the rate among US National Health and Nutrition Examination Survey (NHANES) participants of similar age. However, the prevalence of dyslipidaemia, at 56.5%, was closer to that of NHANES participants aged in their mid-40s. Despite this, only 0.5% of patients were taking lipid-lowering medications.

In total, 50.8% of the patients smoked, making this habit “dramatically more frequent” than in similarly aged NHANES participants. Yet no patient was receiving nicotine replacement or other interventions for smoking, say the researchers, suggesting “that early education, engagement, and smoking cessation treatments are needed” for patients with first-episode schizophrenia.

Likewise, 39.9% of patients had prehypertension and 10.0% had hypertension, but just 3.6% were taking antihypertensive drugs.

“Importantly, the relatively high prevalences of hypertension, diabetes, and especially smoking and lipid abnormalities are in stark contrast to the lack of related medical treatment in most patients”, writes the team in JAMA Psychiatry.

“The underrecognition and undertreatment of cardiometabolic risk factors, especially lipid abnormalities, are consistent with previous reports among patients with chronic schizophrenia and antipsychotic-treated patients and are likely modifiable reasons for premature mortality in schizophrenia.”

Measures of body composition, including body mass index and fat mass, were positively associated with the duration of psychiatric illness. The ratio of triglycerides to high-density lipoprotein (HDL) cholesterol was also associated with illness duration, but was more strongly associated with the duration of antipsychotic treatment.

HDL cholesterol fell and triglycerides rose with increasing duration of treatment. However, longer duration of antipsychotic treatment correlated with lower systolic blood pressure, which Correll et al say is “consistent with the α-adrenergic blockade of many antipsychotics.”

Glucose levels also fell with increasing treatment duration, although the team cautions that this was based on data for just 99 patients.

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