Low-density lipoprotein cholesterol in patients treated with atypical antipsychotics: missed targets and lost opportunities.

BACKGROUND

The treatment of psychotic disorders with second-generation antipsychotics (SGAs) has been linked to an increased risk of coronary heart disease (CHD). Lowering low-density lipoprotein-cholesterol (LDL-C) to individualized targets of 100, 130 or 160 mg/dl reduces the risk of CHD. We determined the prevalence of above-target LDL-C and its management during psychiatric hospitalization.

METHODS

364 hospitalized adults receiving SGAs underwent LDL-C target assessments. Records of patients with above-target LDL-C were searched for dietary or pharmacologic treatments and referrals for medical consultation.

RESULTS

Above-target LDL-C levels were present in 100 (27.5%) patients and were associated with higher total cholesterol, lower high-density lipoprotein cholesterol, older age, higher systolic blood pressure, smoking and male gender (r(2): 0.53; p<0.0001). Only 32.0% of these patients received appropriate interventions during hospital stays of 27.6+/-23.3 days.

CONCLUSIONS

A substantial number of SGA-treated patients have above-target LDL-C, but do not receive interventions to reduce the risk of CHD.