Aiming for healthy hearts: Tracking risk factors

A routine clinical system for monitoring cardiovascular disease (CVD) risk factors in mental health patients is being developed with a view to reducing their high risk.

The life expectancy of people with schizophrenia is considerably shorter than that of the general population, in large part due to a much increased risk of CVD.

Statistically, people with schizophrenia are more likely to smoke, have an unhealthy diet, be physically inactive and have higher body mass indices.

There is also evidence that the use of some antipsychotic medications is associated with weight gain, glucose dysregulation and lipid (fat) abnormalities, all of which are associated with an increased risk of CVD.

Since factors such as illness, lifestyle and medication are all involved in increased risk for CVD, it is possible for people to reduce their individual risk.

The first step in developing risk reduction programs is the availability of high-quality, clinically relevant data. The Clinical Applications Unit (CAU) and the Graylands Pharmacy-led Study of the Antipsychotic Effects on Metabolic Syndrome (SAEMS) are collaborating to develop a routine, clinically feasible system for monitoring CVD risk factors in all North Metropolitan Area Health Service mental health patients treated with antipsychotic medications.

Ms Carole Harrison, who joined CAU in February, will run the project. CAU anticipates at this stage that it will take about 12 months to develop a working register of information.

Evidence of the increased risk of CVD was backed up by the findings of researchers from the University of Western Australia’s Centre for Clinical Research in Neuropsychiatry and a co-author who carried out the first Australian study to measure the prevalence of metabolic syndrome among people with a range of psychiatric disorders.

Their study of 203 adults who attended the Armadale Mental Health Service, almost half of whom had schizophrenia, found the incidence of metabolic syndrome was more than double that of the rest of the population (estimated to be around 25 percent). People with bipolar disorder ranked highest with rates of nearly 67 percent.

Metabolic syndrome, also known as "MetS" or "insulin resistance syndrome," is associated with obesity, high blood pressure and high cholesterol.

Lead author Alexander John said the increased prevalence of MetS may be due to factors such as poor diet and lack of exercise as well as a possible link to some atypical antipsychotic drugs.

"Prevention, monitoring and treatment of cardiovascular disease risk factors should be considered a priority by those involved in the care of the people with major psychiatric disorders," he said.

(Source: University of Western Australia: Medical Journal of Australia: August 2009)