Metabolic

Monitoring of cardiometabolic markers important for patients on antipsychotics

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Physicians should monitor cardiometabolic markers in patients on antipsychotics according to the results of a retrospective study presented at the American Psychiatric Association’s annual meeting.

Notable markers include hemoglobin A1C, lipid panels, and BMI, which are regularly assessed.

Arun George Prasad

“Educated decisions regarding antipsychotics for patients based on their risk profile and the risk-benefit ratio for the effectiveness of certain antipsychotics need to be considered.” Arun George Prasad, MD, the department of psychiatry at the Bronx Care Hospital Center, said Healio Psychiatry. “Dose reductions and changes in antipsychotics must be performed if adverse cardiometabolic profiles develop.”

According to Prasad and colleagues, notable side effects of second-generation antipsychotics include an increased risk of weight gain, elevated lipid levels, and increased insulin resistance, which can lead to an increased risk of diabetes. Patients with psychotic disorders who experience these risk factors may have increased cardiovascular mortality and reduce life expectancy. Researchers conducted the current study at a community mental health clinic in an underserved urban community with a census of over 3,300 patients, approximately 50% of whom were prescribed one or more antipsychotics. In 2013, the hospital initiated a resident-led performance improvement project for annual cardiometabolic factors monitoring using the electronic metabolic records and introduced a hard stop preventing providers from issuing further prescriptions until values ​​were entered. Prasad and colleagues performed a retrospective chart review that obtained baseline data from cardiometabolic markers, including mean BMI, hemoglobin A1C, fasting glucose, and lipid panel values, from 160 patients prescribed Zyprexa, Seroquel, or both in 2018 and who were offered to switch to one of several different antipsychotics. The researchers re-examined this population in 2019 for comparison.

The results showed elevated cardiometabolic markers in several patients. Those who received quetiapine and olanzapine had higher elevations in cardiometabolic markers compared to other antipsychotics. Certain antipsychotics lowered cardiometabolic markers after one year.

“Clozapine, olanzapine, and quetiapine have been shown to cause maximal cardiometabolic disorders, so caution should be exercised when using these potent antipsychotics,” said Prasad.

Reference:

Prasad A. “The voices stopped, but I picked up!”: A retrospective study of the effects of atypical antipsychotics on cardiometabolic markers. Presented at: American Psychiatric Association Annual Meeting; May 1st to 3rd, 2021 (virtual meeting).

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American Psychiatric Association Annual Meeting

American Psychiatric Association Annual Meeting

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