Cardiometabolic marker monitoring important for patients on antipsychotics
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Physicians should monitor cardiometabolic markers among patients on antipsychotics, according to results of a retrospective study presented at the American Psychiatric Association’s annual meeting.
Markers of note include hemoglobin A1C, lipid panels and BMI, periodically assessed.
“Educated choices regarding antipsychotics for patients based on their risk profile and risk-benefit for efficacy using particular antipsychotics must be kept in mind,” Arun George Prasad, MD, of the department of psychiatry at Bronx Care Hospital Center, told Healio Psychiatry. “Dose reductions and switching of antipsychotics must be implemented if unfavorable cardiometabolic profiles develop.”
According to Prasad and colleagues, notable side effects of second-generation antipsychotics include increased risk for weight gain, elevated lipid values and increased insulin resistance, which can lead to increased risk for diabetes. Patients with psychotic disorder who experience these risk factors may have increased cardiovascular mortality and reduce life expectancy. The researchers’ conducted the current study in a community mental health clinical located in an underserved urban community with a census of over 3,300 patients, approximately 50% of whom were prescribed one or more antipsychotic medication. In 2013, the hospital initiated a resident-run performance improvement project for annual monitoring of cardiometabolic factors that utilized the Electronic Metabolic Records and incorporated a hard stop that prevented providers from proceeding with further prescriptions until values were entered. Prasad and colleagues conducted a retrospective chart review that obtained baselined data of cardiometabolic markers, including average BMI, hemoglobin A1C, fasting glucose and lipid panel values of 160 patients who were prescribed Zyprexa, Seroquel or both in 2018 and who were offered to switch to a different antipsychotic. The researchers reexamined this population in 2019 for comparison.
Results showed elevated cardiometabolic markers among multiple patients. Those on quetiapine and olanzapine had higher elevations in cardiometabolic markers compared with those on other antipsychotics. Certain antipsychotics lowered cardiometabolic markers after a year.
“Clozapine, olanzapine and quetiapine have been shown to cause maximum cardiometabolic derangements, and hence caution must be used while using these efficacious antipsychotics,” Prasad said.
Reference:
Prasad A. “The voices stopped but I gained weight!”: A retrospective study looking at the impact of atypical antipsychotics on cardiometabolic markers. Presented at: American Psychiatric Association Annual Meeting; May 1-3, 2021 (virtual meeting).