Identification of high-risk coronary heart disease patients receiving atypical antipsychotics: single low-density lipoprotein cholesterol threshold or complex national standard?
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.


METHODS
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 LDL cholesterol.


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 identified.


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.
Correll
Christoph U
CU
Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY 11004, USA. ccorrell@lij.edu
Kane
John M
JM
Manu
Peter
P
D000328:Adult; D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood*; D003327:Coronary Disease / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D018570:Risk Assessment; D012559:Schizophrenia / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D013053:Spectrophotometry; D014481:United States / Q000453:epidemiology
D008078:Cholesterol, LDL