Identification of High-Risk Coronary Heart Disease Patients Receiving Atypical Antipsychotics: Single Low-Density Lipoprotein Cholesterol Threshold or Complex National Standard?
J Clin Psychiatry 2008;69(4):578-583
© Copyright 2017 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
Objective: Although psychiatric patients have a shortened life
expectancy due to increased coronary heart disease (CHD), early identification
of high-risk patients and targeted prevention for reduction of low-density
lipoprotein (LDL) cholesterol are suboptimal in clinical care. We aimed to
compare the accuracy of a single LDL-cholesterol intervention threshold of >
130 mg/dL (recently proposed for psychiatric patients) with that of the more
complex LDL-cholesterol targets defined by the National Cholesterol Education
Panel (NCEP). The study was performed in patients receiving second-generation
antipsychotics (SGAs), a medication class associated with CHD risk.
Method: Three hundred fifty-six psychiatric patients receiving
SGAs underwent standard LDL-cholesterol target assessments upon admission to
the hospital between August 1, 2004, and March 1, 2005. The expert
consensus-recommended > 130-mg/dL LDL-cholesterol threshold was used to
determine false-negative results among patients with above-target NCEP-defined
LDL cholesterol and false-positive results in the group with below-target NCEP-defined
Results: The > 130-mg/dL threshold misclassified 15 (14.9%) of
101 high-risk patients and 31 (12.2%) of 255 low-risk patients (mean ± SD
10-year CHD risk: 23.1% ± 12.2% and 2.1% ±2.2%, respectively). Results were
similar in the 171 schizophrenia patients. Misclassified patients with
above-target LDL cholesterol were more likely than correctly identified
patients to have diabetes (p = .0002), greater 10-year CHD risk (p = .0006),
higher age (p = .0008), metabolic syndrome (p = .0018), and past CHD events (p
= .0025). No distinguishing factors for false-positive cases could be
Conclusions: The > 130-mg/dL LDL-cholesterol intervention
threshold operated poorly in our psychiatric population. To avoid substandard
care, NCEP-defined LDL-cholesterol targets should be used for the routine
detection of psychiatric patients treated with antipsychotics who require
interventions to decrease CHD risk.