Www.uchc.edu METABOLIC SYNDROME IN A CORRECTIONS POPULATION TREATED WITH ANTIPSYCHOTICS Andrew M....
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Transcript of Www.uchc.edu METABOLIC SYNDROME IN A CORRECTIONS POPULATION TREATED WITH ANTIPSYCHOTICS Andrew M....
www.uchc.edu
METABOLIC SYNDROME IN A CORRECTIONS POPULATION TREATED WITH ANTIPSYCHOTICS
Andrew M. Cislo, PhDMegan J. Ehret, PharmD, MS, BCPP
Robert L. Trestman, MD, PhDKirsten Shea, MBA
Background
• Metabolic Syndrome: “…a group of risk factors that occur together and increase the risk for coronary artery disease, stroke, and type 2 diabetes”
• obesity, glucose intolerance, dyslipidemia, hypertension
• 3 or more risk factors for diagnosis
A.D.A.M. Medical Encyclopedia
Background
Risk Factor Defining Level
Abdominal obesity
Men >102 cm
Women >88 cm
Triglycerides >=150 mg/dL
HDL cholesterol
Men <40 mg/dL
Women <50 mg/dL
Blood Pressure >=135/>85 mm Hg
Fasting Glucose >=100 mg/dL
Table adapted from Grundy et al 2004; NCEP/ATPIII Guidelines
Background
• Community Prevalence of Metabolic Syndrome: 24-34%
• Physical Activity• Poor Nutrition• Substance Abuse• Smoking• Culture/Diet
Older ageGender * Race/ethnicityOverweight
Ford 2002; ADA 2004; Holt 2004; Petty 2003; Ervin 2009
Background
• Are these risk factors similarly distributed in community and prison populations?
•No!
• Younger, great majority male, over-representation of minorities, adequate nutrition, very limited substance use, no smoking
• Also – Over-representing SMI
Background
• Rates of MS significantly higher among SMI• ~41%
• Second generation, or atypical, antipsychotics associated with increased MS risk
McEvoy et al 2005
Background
ClozapineOlanzapineQuetiapineRisperidonePaliperidone
AripiprazoleLurasidoneIloperidoneZiprasidoneAsenapine
Stahl SM 2009; De Hert M 2009; Nussbaum 2008; Scott LH 2009; Meltzer HY 2009; Weber J 2009
Background
• Correctional Managed Health Care (CMHC) at UConn Health Center
• Responsibility for all global medical, mental health, pharmacy, and dental service provision in integrated jail and prison system.
• 2 phase project• Administrative data alone (described below)• Medical chart review to enable use of NCEP/ATP III
Guidelines
Background
• Two Major Contributions
• First study of MS prevalence by antipsychotics with incarcerated population
• Individual variation (with environmental controls)
• Method: Compare MS measurement criteria• Traditional• Modified (for use with existing electronic
data)
Background
• UConn IRB approval
• Awaiting CT DOC determination
Research Questions
Are atypical antipsychotics generally associated with elevated risk for MS in corrections?
Does Rx risk for MS align with relative risk in community studies?
Method
CMHC e-pharmacy records July 2010-June 2012
Inclusion Criteria Qualifying 1st or 2nd generation antipsychotic
Rx fill during window Received med. for at least 6 months If fills in both gens (not concurrently):
First med. if >=6 months & 1 fill in window
Method
Exclusion Criterion No med in other generation concurrently
Method
Analytic Categories
First Gen Only Second Gen Only
First to Second Gen Second to First Gen
Method
Dependent Variable Metabolic Syndrome
>=3 of the following BMI>=25 Rx lipid modifying agent Rx antihypertensive medication Rx diabetic medication
(Einhorn D. 2003, Lambert BL 2005, Lambert BL 2005)
Method
• Other Covariates• Race/ethnicity• Gender• Age• Time since admission
• Anovas and Logistic Regressions
Sample Description (N=X)% Race/Ethnicity
White Black Hispanic
% Age Group<40 years 40+ years
% SexMale Female
Sample Description (N=X)
% Rx Generation First Gen Only Second Gen Only First to Second Second to First
% Ever 2nd GenEver Second
% Outcome
Metabolic Syndrome
Limitations
• Time ordering
• Sequencing of Rx history
• Window and sample size
• Administrative data
• Lack of randomization
Future Directions
• Medical chart reviews required• Height/weight (more complete)• Lab values: glucose, cholesterol panels• Sequencing of antipsychotic Rx
• Inclusion of additional medications• Mood stabilizers- lithium, valproic acid• Antidepressants
• Stratify by psychiatric Dx
Future Directions
Replication
Do other states have comparable electronic data for comparison?
www.uchc.edu
Contact Information
Andrew M. Cislo, PhDDirector of Research and EvaluationCorrectional Managed Health Care
University of Connecticut Health Center263 Farmington Avenue, ASB Bldg., 3rd floor
Farmington, CT 06030-5386Phone: 860-282-8575Email: [email protected]