Long-Term Health-Promoting Interventions Improve Cardiovascular Risk in Schizophrenia

Psychiatry Advisor Contributing Writer
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Woman gestures while discussing something difficult during a support group or group therapy session. A mental health professional is taking notes in the background.
Researchers found that their study interventions improved cardiovascular disease risk significantly over a 30-month period, likely due to the amelioration of hypertension due to an adjustment to the diagnosis of schizophrenia and healthy lifestyle changes.

According to a study published in the American Journal of Therapeutics, patients with first episode schizophrenia already show increased cardiovascular risk factors prior to starting treatment: An intervention period regarding lifestyle modifications of ≥30 months is needed to reduce risk in these patients.

The investigators of this naturalistic study sought to understand the prevalence of abnormal cardiovascular risk factor values in patients with first episode schizophrenia and the trajectory of cardiovascular risk factors, while patients received nonpharmacological health-promoting interventions. The study sample included 136 patients newly diagnosed with first episode schizophrenia recruited from 2 outpatient clinics in Denmark. The participants were enrolled in a 30-month supplementary program consisting of group sessions and monthly individual consultations, along with normal treatment and care. Nonpharmaceutical interventions included discussing health problems and methods for improving health and monitoring clinical values, such as weight, waist circumference, and blood measurements.

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Outcomes of interest were the prevalence of abnormal cardiovascular risk factors, including body mass index (BMI), waist circumference, weight and body fat percentage, blood pressure, and pulse. Blood test outcomes included total cholesterol, high- and low-density lipoprotein cholesterol, triglycerides, and glucose levels. The patients’ visceral adiposity index was used to define adipose tissue dysfunction. The longitudinal mixed-effect analysis was used to estimate both linear and quadratic risk factor trajectories.

Prevalence of abnormal cardiovascular risk factors was 21% to 81.8% in patients previously treated with antipsychotics and 8.3% to 83.3% in patients who were antipsychotic-naïve. Overall, patients with first episode schizophrenia demonstrated elevated cardiovascular risk factors at baseline:

·56.8% of the sample was overweight,

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·50.4% had a much-increased waist circumference, and

·81.8% had a high body fat percentage and hypertension.

Only 20% had normal blood pressure. During the 30-month intervention period, risk factors of weight and waist circumference increased during the first 581 and 646 days, respectively, and then began to decrease. Most of the cardiovascular risk factors demonstrated nonlinear trajectories with values improving only after 1 to 2 years.

Limitations to the study included the inability to guarantee perfect adherence to the program and no available adherence data. The motivational status of the patients was not monitored during the intervention, which may have improved the effects of treatment. Furthermore, no data was available on the duration of untreated psychosis.

Patients with first episode schizophrenia had a high prevalence of cardiovascular risk factors at baseline. The effects of health-promoting programs followed a quadratic trajectory, in which improvement was ascertained over longer observation periods ˃1 year. The investigators suggest physical health should be part of treatment and long-term interventions of ≥30 months, regarding lifestyle modification are needed in this population.

Reference          

Søgaard HJ, Højlund M, Elliott A, et al. Effect of a 30-month health-promoting program on the prevalence of cardiovascular risk factors in patients with first episode schizophrenia [published online January 18, 2019]. Am J Ther. doi: 10.1097/MJT.0000000000000708