Magazine article Clinical Psychiatry News
Interventions Reduced Psychiatric Patients' Cardiometabolic Risk Factors
FORT LAUDERDALE, FLA. -- Psychiatrists can do more to affect modifiable cardiometabolic risk factors prevalent in patients with mental health disorders, a leading researcher suggests.
"We don't have to solve the whole problem to get a big win for our patients," Dr. John W. Newcomer said at the annual meeting of the American College of Psychiatrists.
If psychiatrists can get patients to drop their total cholesterol by 10%, it can result in a 30% reduction in 10-year coronary heart disease (CHD) hard event rates. Lowering diastolic blood pressure by just 6 mm Hg can significantly reduce the 10-year risk of myocardial infarction by 16% and stroke by 42%.
Getting patients to quit smoking cigarettes, which is a prevalent behavior in this population, has a "huge payoff" with about a 50% reduction in 10-year CHD event risk, said Dr. Newcomer, the Gregory B. Couch professor of psychiatry at Washington University in St. Louis.
Clinicians can modify patient risk through the use of monitoring and interventions, including appropriate primary care provider and specialty referrals, and the use of medications with a lower potential for adverse metabolic effects, said Dr. Newcomer, also of the psychology and medicine departments at the university. In 2003-2004, the Food and Drug Administration instituted warnings on diabetes risk for second-generation antipsychotic (SGA) drugs. Both the American Psychiatric Association and American Diabetes Association (ADA) simultaneously recommended screening and monitoring for all patients who receive SGAs.
Despite the combined warning and recommendations, three recent studies co-led by Dr. Newcomer show "that not much has changed," he said. "Education is not enough." Interventions are needed to improve those metrics, he said.
The most recent of these studies used claims data from California, Missouri, and Oregon state Medicaid programs to compare metabolic testing rates from Jan. 1, 2002, to Dec. 31, 2005, among 33,212 propensity-matched pairs of persistent SGA and albuterol users. Initial testing rates for SGA-treated patients were low at 27% for glucose and 10% plasma lipids, reported Dr. Newcomer and co-investigator Elaine H. Morrato, Dr.P.H., with the University of Colorado Denver. The warning was not associated with an increase in glucose testing in SGA-treated patients, and was associated with only a marginal 1. …