Metabolic syndrome in outpatients receiving antipsychotic therapy in routine clinical practice: A cross-sectional assessment of a primary health care database
Planning Directorate, Badalona Serveis Assistencials SA, Gaietá Soler, 8-entresuelo, 08911 Badalona (Barcelona), Spain. European Psychiatry
(Impact Factor: 3.44).
04/2008; 23(2):100-8. DOI: 10.1016/j.eurpsy.2007.07.005
To determine the prevalence of metabolic syndrome (MS) in outpatients treated with antipsychotics included in a primary-health-care database.
A cross-sectional study was carried out assessing an administrative outpatients claim-database from 5 primary-health-centers. Subjects on antipsychotics for more than 3 months were included. The control group was formed by the outpatients included in the database without exposition to any antipsychotic drugs. MS was defined according to the modified NCEP-ATP III criteria, and required confirmation of at least 3 of the 5 following components: body mass index >28.8 kg/m(2), triglycerides >150 mg/ml, HDL-cholesterol <40 mg/ml (men)/<50mg/ml (women), blood pressure >130/85 mmHg, and fasting serum glucose >110 mg/dl.
We identified 742 patients [51.5% women, aged 55.1 (20.7) years] treated with first- or second-generation antipsychotics during 27.6 (20.3) months. Controls were 85.286 outpatients [50.5% women, aged 45.5 (17.7) years]. MS prevalence was significantly higher in subjects on antipsychotics: 27.0% (95% CI, 23.8-30.1%) vs. 14.4% (14.1-14.6%); age- and sex-adjusted OR=1.38 (1.16-1.65, P<0.001). All MS components, except high blood pressure, were significantly more prevalent in the antipsychotic group, particularly body mass index >28.8 kg/m(2): 33.0% (29.6-36.4%) vs. 17.8% (17.6-18.1%), adjusted OR=1.63 (1.39-1.92, P<0.001), and low HDL-cholesterol levels: 48.4% (44.8-52.0%) vs. 29.3% (29.0-29.6%); adjusted OR=1.65 (1.42-1.93, P<0.001). Compared with the reference population, subjects with schizophrenia or bipolar disorder (BD), but not dementia, showed a higher prevalence of MS.
Compared with the general outpatient population, the prevalence of MS was significantly higher in patients with schizophrenia or BD treated with antipsychotics.
Available from: Evangelos Papanastasiou
- "Numerous studies compared prevalence rates between men and women. Most studies revealed substantially increased prevalence rates of MetS in women [Cohn et al. 2004; Kato et al. 2004; McEvoy et al. 2005; Correll et al. 2006; De Hert et al. 2006b; Hagg et al. 2006; Lamberti et al. 2006; Meyer et al. 2006; Bobes et al. 2007; Teixeira and Rochal, 2007; Cerit et al. 2008; Rejas et al. 2008; Sicras-Mainar et al. 2008; Huang et al. 2009; Rezaei et al. 2009; Yazici et al. 2011], up to threefold compared with men [Rezaei et al. 2009]. Fewer studies reported a slight predominance of male sex in MetS rates or no significant differences in rates of MetS across sexes [Heiskanen et al. 2003; Basu et al. 2004; Tirupati and Chua, 2007; Correll et al. 2008; Koponen et al. 2010; Kraemer et al. 2010; Sugawara et al. 2010, 2011]. "
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ABSTRACT: Metabolic syndrome (MetS), a constellation of central obesity, hypertension, dyslipidaemia and glucose intolerance, is highly prevalent in individuals with schizophrenia and conveys significant cardiovascular risk and mortality. Associated risk factors are female sex, some ethnic groups, advanced age, long duration of illness, smoking and exposure to antipsychotic agents. The prevalence of MetS varies across countries and psychiatric populations, and its development can be very rapid. Regular monitoring of all features of MetS is the cornerstone of its early detection and management. Future research needs to focus more on genetic determinants of MetS in the context of schizophrenic illness. This review aims to update the reader with the latest knowledge about the prevalence of MetS in schizophrenia and what might be the underlying pathophysiological mechanisms.
Available from: Jaume Benavent Areu
- "Spanish health authorities are not convinced that PCS are able to respond to the management needs of PHC: there is still no normalized Minimum Basic Data Set (MBDS-PHC) in Spain and there seem to be doubts on the efficacy of PCS and their adjustment to the characteristics of a health context different to that for which they were designed . "
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The main objective of this study is to measure the relationship between morbidity, direct health care costs and the degree of clinical effectiveness (resolution) of health centres and health professionals by the retrospective application of Adjusted Clinical Groups in a Spanish population setting. The secondary objectives are to determine the factors determining inadequate correlations and the opinion of health professionals on these instruments.
We will carry out a multi-centre, retrospective study using patient records from 15 primary health care centres and population data bases. The main measurements will be: general variables (age and sex, centre, service [family medicine, paediatrics], and medical unit), dependent variables (mean number of visits, episodes and direct costs), co-morbidity (Johns Hopkins University Adjusted Clinical Groups Case-Mix System) and effectiveness.
The totality of centres/patients will be considered as the standard for comparison. The efficiency index for visits, tests (laboratory, radiology, others), referrals, pharmaceutical prescriptions and total will be calculated as the ratio: observed variables/variables expected by indirect standardization.
The model of cost/patient/year will differentiate fixed/semi-fixed (visits) costs of the variables for each patient attended/year (N = 350,000 inhabitants). The mean relative weights of the cost of care will be obtained. The effectiveness will be measured using a set of 50 indicators of process, efficiency and/or health results, and an adjusted synthetic index will be constructed (method: percentile 50).
The correlation between the efficiency (relative-weights) and synthetic (by centre and physician) indices will be established using the coefficient of determination. The opinion/degree of acceptance of physicians (N = 1,000) will be measured using a structured questionnaire including various dimensions. Statistical analysis: multiple regression analysis (procedure: enter), ANCOVA (method: Bonferroni's adjustment) and multilevel analysis will be carried out to correct models. The level of statistical significance will be p < 0.05.
Available from: Chia-Ming Chang
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ABSTRACT: This study intended to simultaneously investigate the relationships between high-density lipoprotein (HDL) and homeostasis model assessment of insulin resistance (HOMA-IR) in medicated schizophrenic patients vs healthy controls.
During a 1-year period, we recruited 37 medicated schizophrenic patients and 30 healthy controls. Metabolic syndrome-related biomarkers including insulin and lipid profiles were enzymatically determined.
An analysis of covariance (ANCOVA) with BMI adjustment revealed that the patients had significantly lower HDL levels than the healthy controls (p = 0.017). ANCOVA with age adjustment revealed that the patients had significantly higher fasting insulin levels than the healthy controls (p = 0.034). In addition, in comparison with the healthy controls, the patients had higher mean serum levels of triglycerides, low-density lipoprotein, and total cholesterol as well as higher HOMA-IR values. However, there were no significant differences in any marker in the ANCOVA analysis after adjustment for age or BMI.
We found lower HDL and higher insulin levels in medicated schizophrenic patients than in healthy controls.
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