Cardiometabolic risk high for schizophrenia patients

Oct 17 2013

By Lucy Piper, Senior medwireNews Reporter

The risk for abdominal obesity may be increased as much as fourfold for patients with multi-episode schizophrenia compared with the rest of the population, reveal findings from a meta-analysis.

These patients are also at heightened risk for other cardiometabolic abnormalities, such as low levels of high-density lipoprotein (HDL) cholesterol, the metabolic syndrome, hypertriglyceridemia, and diabetes.

The findings support guidelines from the World Psychiatric Association recommending physical health screening and monitoring in patients with schizophrenia, say the researchers, led by Davy Vancampfort (University Psychiatric Centre KU Leuven, Belgium). And they highlight the need for patients with schizophrenia and their family members to be educated about the possibility of cardiometabolic risk.

The team conducted a meta-analysis of 136 studies, involving 185,606 patients with schizophrenia, 28 of which provided data on nearly 3,900,000 population controls matched for age and gender.

Patients with multi-episode schizophrenia were 4.43 times more likely to have abdominal obesity than controls, while the odds for low HDL cholesterol, the metabolic syndrome, and hypertriglyceridemia were more than doubled, at 2.35, 2.35, and 2.73, respectively.

The risk for diabetes was almost doubled in these patients, and the risk for hypertension was increased 1.36-fold.

The risk for these conditions in multi-episode schizophrenia patients was also significantly increased compared with that for first-episode or drug-naïve patients, with the exception of diabetes and hypertension.

Given the high rates of metabolic abnormalities, the researchers propose that schizophrenia patients should, at the very least, have their waist circumference measured regularly, and, ideally, also their fasting glucose, triglyceride, HDL cholesterol, and hemoglobin A1C levels.

They also advocate the routine screening of cardiovascular risk factors at key stages to establish a risk profile for patients that takes into account their personal and family history.

“This risk profile should afterwards be used as a basis for ongoing monitoring, treatment selection and management,” the researchers write in World Psychiatry.

Additionally, Vancampfort and colleagues believe it is important to educate patients with schizophrenia and their family members and caregivers about the increased risk for cardiometabolic abnormalities and ways to lessen it, having previously found that many patients are either unaware of the need to make appropriate lifestyle changes or do not possess the knowledge and skills to do so.

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