NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
This publication is provided for historical reference only and the information may be out of date.
Interventions To Improve Cardiovascular Risk Factors in People With Serious Mental Illness
Comparative Effectiveness Reviews, No. 105
Investigators: Jennifer M Gierisch, PhD, MPH, Jason A Nieuwsma, PhD, Daniel W Bradford, MD, MPH, Christine M Wilder, MD, Monica C Mann-Wrobel, PhD, Amanda J McBroom, PhD, Liz Wing, MA, Michael D Musty, BA, Megan M Chobot, MSLS, Vic Hasselblad, PhD, and John W Williams, Jr, MD, MHSc.
Author Information and AffiliationsStructured Abstract
Objectives:
Individuals with serious mental illness (SMI) have excess mortality from cardiovascular disease (CVD) and high rates of CVD risk factors such as diabetes, obesity, and hyperlipidemia. We conducted a systematic review to evaluate interventions to improve CVD risk factors in adults with SMI.
Data Sources:
We searched PubMed®, Embase®, PsycINFO®, and the Cochrane Database of Systematic Reviews for English-language trials published since 1980 that evaluated patient-focused behavioral interventions, peer or family support interventions, pharmacological treatments, and multicondition lifestyle interventions, or their combination, that targeted weight control, glucose levels, lipid levels, or CVD risk profile among adults with SMI at elevated risk of CVD.
Review Methods:
Two investigators screened each abstract and full-text article for inclusion, abstracted data, and performed quality ratings, efficacy–effectiveness ratings, and evidence grading. Qualitative and quantitative methods, using random-effects models, were used to summarize results.
Results:
Of 35 eligible studies, most enrolled patients with schizophrenia who were prescribed antipsychotics. Most studies were designed to control weight (n=28); one study specifically addressed diabetes management, none targeted hyperlipidemia, and three were multicondition interventions. Most studies were efficacy trials comparing behavioral interventions with control; none evaluated peer and family support. There were few direct comparisons of active interventions; effects on overall CVD risk, physical functioning, or cardiovascular events were reported rarely.
Compared with controls, behavioral interventions (mean difference [MD] −3.13 kg; 95% CI, −4.21 to −2.05), metformin (MD −4.13 kg; CI, −6.58 to −1.68), the anticonvulsive medications topiramate and zonisamide (MD −5.11kg; CI, −9.48 to −0.74), and adjunctive or antipsychotic switching to aripiprazole improved weight control. However, aripiprazole switching may be associated with higher rates of treatment failure. Nizatidine did not improve any outcome. The evidence was insufficient for all other interventions and effects on glucose and lipid control.
Conclusions:
Few studies have evaluated interventions to address one or more CVD risk factors in patients with SMI. Comparative effectiveness studies are needed to test multimodal strategies, agents known to be effective in non-SMI populations, and antipsychotic-management strategies.
Contents
- Preface
- Acknowledgments
- Key Informants
- Technical Expert Panel
- Peer Reviewers
- Executive Summary
- Introduction
- Methods
- Results
- Introduction
- Results of Literature Searches
- Description of Included Studies
- Key Question 1 Effectiveness of Weight-Management Interventions
- Key Question 2 Effectiveness of Diabetes-Management Interventions
- Key Question 3 Effectiveness of Dyslipidemia-Management Interventions
- Key Question 4 Effectiveness of Multicondition Lifestyle Interventions
- Discussion
- References
- Abbreviations
- Appendix A Exact Search Strings
- Appendix B Efficacy–Effectiveness Rating Form
- Appendix C Data Abstraction Elements
- Appendix D Included Studies
- Appendix E Excluded Studies
- Appendix F Study Characteristics Table
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10066-I, Prepared by: Duke Evidence-based Practice Center, Durham, NC
Suggested citation:
Gierisch JM, Nieuwsma JA, Bradford DW, Wilder CM, Mann-Wrobel MC, McBroom AJ, Wing L, Musty MD, Chobot MM, Hasselblad V, Williams JW Jr. Interventions To Improve Cardiovascular Risk Factors in People With Serious Mental Illness. Comparative Effectiveness Review No. 105. (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-2007-10066-I.) AHRQ Publication No. 13-EHC063-EF. Rockville, MD: Agency for Healthcare Research and Quality. April 2013. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the Duke Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10066-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
- 1
540 Gaither Road, Rockville, MD 20850; www
.ahrq.gov
- Review Pharmacologic and behavioral interventions to improve cardiovascular risk factors in adults with serious mental illness: a systematic review and meta-analysis.[J Clin Psychiatry. 2014]Review Pharmacologic and behavioral interventions to improve cardiovascular risk factors in adults with serious mental illness: a systematic review and meta-analysis.Gierisch JM, Nieuwsma JA, Bradford DW, Wilder CM, Mann-Wrobel MC, McBroom AJ, Hasselblad V, Williams JW Jr. J Clin Psychiatry. 2014 May; 75(5):e424-40.
- Review Behavioral Counseling to Promote a Healthy Lifestyle for Cardiovascular Disease Prevention in Persons With Cardiovascular Risk Factors: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force[ 2014]Review Behavioral Counseling to Promote a Healthy Lifestyle for Cardiovascular Disease Prevention in Persons With Cardiovascular Risk Factors: An Updated Systematic Evidence Review for the U.S. Preventive Services Task ForceLin JS, O'Connor EA, Evans CV, Senger CA, Rowland MG, Groom HC. 2014 Aug
- Review Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force[ 2015]Review Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task ForcePatnode CD, Henderson JT, Thompson JH, Senger CA, Fortmann SP, Whitlock EP. 2015 Sep
- Review Aspirin Use in Adults: Cancer, All-Cause Mortality, and Harms: A Systematic Evidence Review for the U.S. Preventive Services Task Force[ 2015]Review Aspirin Use in Adults: Cancer, All-Cause Mortality, and Harms: A Systematic Evidence Review for the U.S. Preventive Services Task ForceWhitlock EP, Williams SB, Burda BU, Feightner A, Beil T. 2015 Sep
- Review Treatment Strategies for Patients With Peripheral Artery Disease[ 2013]Review Treatment Strategies for Patients With Peripheral Artery DiseaseJones WS, Schmit KM, Vemulapalli S, Subherwal S, Patel MR, Hasselblad V, Heidenfelder BL, Chobot MM, Posey R, Wing L, et al. 2013 May
- Interventions To Improve Cardiovascular Risk Factors in People With Serious Ment...Interventions To Improve Cardiovascular Risk Factors in People With Serious Mental Illness
Your browsing activity is empty.
Activity recording is turned off.
See more...