Changes in metabolic parameters in patients with severe mental illness over a 10-year period: A retrospective cohort study

Heald, Adrian; Martin, Julie Langan; Payton, Antony; Khalid, Luma; Anderson, Simon; Narayanan, Ram Prakash; Hert, Marc De; Yung, Alison R.; Livingston, Mark

doi:10.1177/0004867415625817

Cited by 15 publications

(14 citation statements)

References 37 publications

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“…Importantly, our results provide the first evidence that cholesterol concentration is reduced by over 1 mmol/L for up to 2 years, which suggests that medication adherence is sustained. This finding is important because it suggests—in agreement with other studies54 55—that statin use can result in substantial reductions in cholesterol among populations with high antipsychotic usage. Furthermore, other studies in the general population have shown that the impact of statin prescribing on CVD events increases with extended use: reductions of 0.6 mmol/L of total cholesterol are associated with a 7% decrease in ischaemic heart disease during the first 2 years of therapy and >20% decreases thereafter 56.…”

Section: Discussionsupporting

confidence: 87%

Statin prescribing for people with severe mental illnesses: a staggered cohort study of ‘real-world’ impacts

Blackburn¹,

Osborn²,

Walters³

et al. 2017

BMJ Open

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ObjectivesTo estimate the ‘real-world effectiveness of statins for primary prevention of cardiovascular disease (CVD) and for lipid modification in people with severe mental illnesses (SMI), including schizophrenia and bipolar disorder.DesignSeries of staggered cohorts. We estimated the effect of statin prescribing on CVD outcomes using a multivariable Poisson regression model or linear regression for cholesterol outcomes.Setting587 general practice (GP) surgeries across the UK reporting data to The Health Improvement Network.ParticipantsAll permanently registered GP patients aged 40–84 years between 2002 and 2012 who had a diagnosis of SMI. Exclusion criteria were pre-existing CVD, statin-contraindicating conditions or a statin prescription within the 24 months prior to the study start.ExposureOne or more statin prescriptions during a 24-month ‘baseline’ period (vs no statin prescription during the same period).Main outcome measuresThe primary outcome was combined first myocardial infarction and stroke. All-cause mortality and total cholesterol concentration were secondary outcomes.ResultsWe identified 2944 statin users and 42 886 statin non-users across the staggered cohorts. Statin prescribing was not associated with significant reduction in CVD events (incident rate ratio 0.89; 95% CI 0.68 to 1.15) or all-cause mortality (0.89; 95% CI 0.78 to 1.02). Statin prescribing was, however, associated with statistically significant reductions in total cholesterol of 1.2 mmol/L (95% CI 1.1 to 1.3) for up to 2 years after adjusting for differences in baseline characteristics. On average, total cholesterol decreased from 6.3 to 4.6 in statin users and 5.4 to 5.3 mmol/L in non-users.ConclusionsWe found that statin prescribing to people with SMI in UK primary care was effective for lipid modification but not CVD events. The latter finding may reflect insufficient power to detect a smaller effect size than that observed in randomised controlled trials of statins in people without SMI.

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Section: Discussionsupporting

confidence: 87%

Statin prescribing for people with severe mental illnesses: a staggered cohort study of ‘real-world’ impacts

Blackburn¹,

Osborn²,

Walters³

et al. 2017

BMJ Open

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“…A 10-year follow-up study of 1307 individuals (mean age 56 years) on general practice severe mental illness registers in Cheshire (UK) demonstrated the progression over time with respect to some of these problems (Heald et al, 2016). Mean baseline BMI increased from 28.6 kg/m 2 to 31.0 kg/m 2 ( P =0.0002).…”

Section: Management Of the Increased Risks For Diabetes And Cvdmentioning

confidence: 99%

BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment

et al. 2016

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Excess deaths from cardiovascular disease are a major contributor to the significant reduction in life expectancy experienced by people with schizophrenia. Important risk factors in this are smoking, alcohol misuse, excessive weight gain and diabetes. Weight gain also reinforces service users' negative views of themselves and is a factor in poor adherence with treatment. Monitoring of relevant physical health risk factors is frequently inadequate, as is provision of interventions to modify these. These guidelines review issues surrounding monitoring of physical health risk factors and make recommendations about an appropriate approach. Overweight and obesity, partly driven by antipsychotic drug treatment, are important factors contributing to the development of diabetes and cardiovascular disease in people with schizophrenia. There have been clinical trials of many interventions for people experiencing weight gain when taking antipsychotic medications but there is a lack of clear consensus regarding which may be appropriate in usual clinical practice. These guidelines review these trials and make recommendations regarding appropriate interventions. Interventions for smoking and alcohol misuse are reviewed, but more briefly as these are similar to those recommended for the general population. The management of impaired fasting glycaemia and impaired glucose tolerance ('pre-diabetes'), diabetes and other cardiovascular risks, such as dyslipidaemia, are also reviewed with respect to other currently available guidelines.These guidelines were compiled following a consensus meeting of experts involved in various aspects of these problems. They reviewed key areas of evidence and their clinical implications. Wider issues relating to primary care/secondary care interfaces are discussed but cannot be resolved within guidelines such as these.

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“…There also exists a clear relationship between all classes of psychotropic medications and increased risk of disease in people with SPMI (Robson & Gray 2007). In particular, the prevalence of metabolic syndrome, which indicates increased risk for cardiovascular disease, diabetes, and stroke, is high for people diagnosed with an SPMI, as a result of prescribed antipsychotic medications received (Cunningham et al 2014;Heald et al 2016).…”

Section: Introductionmentioning

confidence: 99%

Access to specialist palliative care services by people with severe and persistent mental illness: A retrospective cohort study

Butler

O’Brien

2017

Int J Mental Health Nurs

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Compared to the general population, people with pre-existing serious and persistent mental illness (SPMI) have higher rates of physical illness and die at an earlier age, raising questions about their palliative and end-of-life care needs when they are diagnosed with an incurable physical illness. In the present study, we explored access to specialist palliative care services within one New Zealand health district. Routinely-collected, de-identified patient information on a cohort of people diagnosed with SPMI, and receiving specialist palliative care services from the Capital and Coast District Health Board (CCDHB), was compared to the general population from the same health district. People with SPMI are 3.5 times less likely to receive specialist palliative services compared to the general population from the Capital and Coast District Health Board. The proportion of people identifying as Māori is 1.2 times higher in the SPMI cohort than the general CCDHB population. The SPMI cohort experiences a higher level of deprivation compared to the general population in the CCDHB. The present study confirms that those diagnosed with an SPMI are less likely to use specialist palliative care services at the end of life. Research using a national dataset is needed to determine whether the study findings are applicable to the national population.

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Changes in metabolic parameters in patients with severe mental illness over a 10-year period: A retrospective cohort study

Abstract: Increasing body mass index relates to increasing rates of dysglycaemia over time. Measures to encourage weight reduction should be key strategies to reduce dysglycaemia rates in severe mental illness. Prescribing statins may have been effective in improving the lipid profile in this group.

Cited by 15 publications

References 37 publications

Statin prescribing for people with severe mental illnesses: a staggered cohort study of ‘real-world’ impacts

Statin prescribing for people with severe mental illnesses: a staggered cohort study of ‘real-world’ impacts

BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment

Access to specialist palliative care services by people with severe and persistent mental illness: A retrospective cohort study

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