Low level of medical recognition and treatmentof cardiovascular risk factors inpatients with schizophrenia in Spain

Low level of medical recognition and treatmentof cardiovascular risk factors inpatients with schizophrenia in SpainM. Bernardo1, J.R. Banegas2, F. Cañas3, J. Casademont4, Y. Riesgo5, C. Varela5,Ricava Study Group1Programa de Esquizofrenia Clinic. Hospital Clinic. Barcelona. Spain.2Departamento de Medicina Preventiva y Salud Pública. Facultad de Medicina. Universidad Autónoma. Madrid. Spain.3Hospital Dr. R. Lafora. Madrid. Spain.4Servicio de Medicina Interna. Hospital de Sant Pau. Barcelona. Spain.5Departamento Médico, Bristol-Myers Squibb. Madrid. Spain.

Presenting Author details:BERNARDO@clinic.ub.esVillarroel, 17008036 Barcelona - SpainTel.: +34 93 227 55 47Fax.: +34 93 227 55 48

DESIGNRationalCV risk factors poorly monitored among schizophrenics- Population at a high risk for CV and metabolic events.

ObjectiveTo describe the level of recognition and therapeutic treatment of cardiovascularrisk factors in schizophrenic patients.

SAMPLE DESCRIPTION

Sociodemographics– Male 72%– Mean age 37.8 (SD 11.3)– Single 73%– Primary studies 43%– Living with parents 57.2%– Permanent sick leave 32.5%

Diagnosis of Schizophrenia– Paranoid schizophrenia subtype 73.5%– Age at first episode 25.1 (SD 8)

Design and Subjects– Cross-sectional, multicenter epidemiological survey– 100 centers, 800 patientsPatients with a diagnosis of schizophrenia (DSM-IV) and attending hospital foradmissionPsychiatric acute units (brief hospitalization units)

Variables– Sociodemographic data and Schizophrenia diagnosis– Physical Examination– Lab parameters– ECG– Other CV risk factors (smoking, alcohol intake…)– History of CV risk factors and other chronic concomitant diseases– Family history

RESULTS

REFERENCES

Figure 1. Unrecognized Cardiovascular Risk Factors

Muck-Jorgensen P, Mors O, Mortensen PB, Ewald H. The schizophrenicpatient in the somatic hospital. Acta Psychiatr Scand Suppl 2000;(407):96-9.(1)

Marder SR, Essock SM, Miller AL, Buchanan RW, Casey DE, Davis JM, etal. Physical health monitoring of patients with schizophrenia. Am J Psychiatry2004 Aug;161(8):1334-49.

13th Biennial Winter Workshop on Schizophrenia4 - 10 February 2006 Davos, Switzerland

BACKGROUNDSchizophrenics are a population in whom the diagnosis and monitoring ofcardiovascular risk factors is less frequent. Some studies highlight a highprevalence of some of these risks, and several guidelines point out theadvisability of routine monitoring. Objective: to describe the level of recognitionand therapeutic treatment of cardiovascular risk factors in schizophrenicpatients.

METHODSCross-sectional descriptive study on schizophrenic patients from acute units.Data on sociodemographics, physical examinations, blood test parameters(fasting), cardiovascular risk factors already diagnosed at hospital admissionand family history of cardiovascular risk factors and cardiovascular events.Each risk factor is defined according to international criteria and/or therapeutictreatment; their level of recognition (documented in the medical history) andtherapeutic treatment according to international guidelines are also recorded.

RESULTS733 evaluable patients (72% men, 28% women, average age 38 (SD 11.3))from 97 acute units (61% of those in Spain) were included. The most commonlyidentified risk factors are showed in Table 3.Hypercholesterolemia is the most prevalent metabolic cardiovascular riskfactor affecting more than the half of the studied schizophrenic patients;however hypercholesterolemia toghether with arterial hypertension anddiabetes is one of the major and causal cardiovascular factors that remainsunrecognized in a number of schizophrenic patients (see Table 3).The same applies to hypertrigliceridemia and obesity as importantcardiovascular factors either conditional or predisposing.The most commonly identified risk factors are alcoholism (73%) and nicotineuse (52%). In spite of that, nearly one third of patients with excessive alcoholconsumption is not identified as meeting a cardiovascular risk factor. Thesame applies to nearly 57% of patients showing obesity, that this conditionis not properly recognized.Risk factors that receive more pharmacological treatment were hypertension(69% of diagnosed cases being treated) and diabetes (41%). However whenonly prevalent cases are considered hyperglicemia-diabetes appears as thecardiovascular risk factor that has more pharmacological intervention whileonly 28% of patients with high values of blood pressure are being treated.Sociodemographic parameters such as gender and age are predictive ofreceiving treatment for the specific studied conditions.From 29 patients with a diagnosis of diabetes, women have a greaterprobability of receiving treatment than men (OR=0.02)(p<0.03). From 26patients with a diagnosis of hypertension, men have a greater probability ofreceiving treatment than women (OR=25.34)(p<0.03). The same patternapplies to hypertrigliceridemia, from 16 patients treated, men have a greaterprobability of receiving treatment than women (OR=17.34)((p<0.03).Patterns of treatment for conditions such as diabetes, arterial hypertension,and hypercholesterolemia resulted in a tendency for the age of the patientas a predictive parameter of receiving treatment, i.e. older schizophrenicswould have more probabilities to receive treatment for those conditions thanyounger patients.

DISCUSSION / CONCLUSIONSFrom the data presented, hypercholesterolemia resulted the most prevalentmetabolic cardiovascular risk factor affecting more than the half of the studiedschizophrenic patients, however it has been shown dislipemias in schizophrenicpatients remain unrecognized and receive pharmacological treatment onlyin 18% of the cases.Certain risk behaviours such as nicotine and excessive alcohol consumptionare properly identified by psychiatrists among schizophrenic patients. Howeveras is the case for obesity more attention regarding international diagnosiscriteria is needed when these conditions are assessed as cardiovascularrisk factors.A complete laboratory blood analysis involving lipid profile and an accurateanamnesis and physical examination would allow at least the recognitionand monitoring of most of those cardiovascular risk factors reported asprevalent in the present study.More comprehensive sample sizes are needed in order to confirm our findingsabout prescription patterns among clinicians, in relation to the treatment ofcardiovascular risk factors in schizophrenic patients.Comorbid metabolic disorders in patients with schizophrenia are prevalentand underrecognized by health care professionals and patients. Thus, it isprudent for the psychiatric community to be aware of comorbid medicalconditions other than risk behaviours.

This study was financed by: