Research Activities, June 2013
New report examines interventions to improve cardiovascular disease risk factors among those with serious mental illness
Comparative Effectiveness Research
A new research review from AHRQ evaluates interventions to improve cardiovascular disease (CVD) risk factors in patients with serious mental illness (SMI). Individuals with SMI have excess mortality from CVD and high rates of CVD risk factors such as diabetes, obesity, and hyperlipidemia.
The review finds that only 35 randomized trials evaluated an intervention to address one or more CVD risk factors in patients with SMI. Most of these trials targeted weight control; few targeted other CVD risk factors. Most studies reported effects on isolated CVD risk factors rather than effects on overall CVD risk. The review finds moderate strength of evidence that behavioral interventions are associated with small decreases in weight (about 3 kg).
There was low strength of evidence that switching antipsychotic medication to aripiprazole or adding metformin or the anticonvulsants, topiramate or zonisamide, are associated with small to moderate decreases in weight. No interventions were found to be effective for glucose control (e.g., metformin) and hyperlipidemia (e.g., statins) in patients with SMI. There was low strength of evidence that a switch to aripiprazole from another antipsychotic improved lipid values. Additional studies are needed to test multimodal strategies, agents known to be effective in populations without SMI (such as statins), and antipsychotic management strategies.
These findings can be found in the research review, Interventions To Improve Cardiovascular Risk Factors in People With Serious Mental Illness at http://go.usa.gov/Tz7j.