Baseline Cardiovascular Risk Factors in Patients With Severe Mental Illness (SMI) and Second Generation Antipsychotic Use From the Fixed Dose Intervention Trial of New England Enhancing Survival in SMI (FITNESS)

Virginie-Anne Chouinard, MD ; Mary Price, MA ; Sophie Forte, NP ; Steven Prete, RN ; Hadley Heinrich, BA ; Samantha N. Smith, BS ; Vicki Fung, PhD ; John Hsu, MD ; Dost Ongur, MD, PhD

J Clin Psychiatry 2025;86(1):24m15392

Abstract

Objective: Individuals with severe mental illness (SMI) have a shorter life expectancy compared to the general population, largely due to cardiovascular disease (CVD). In this report from the Fixed Dose Intervention Trial of New England Enhancing Survival in SMI Patients (FITNESS), we examined baseline CVD risk factors and their treatment in patients with SMI and second generation antipsychotic (SGA) use.

Methods: FITNESS enrolled 204 participants with SMI and SGA use, but without documented history of CVD or diabetes mellitus, from several clinics in the Boston, Massachusetts, area between April 29, 2015, and September 26, 2019. We measured CVD risk factors (eg, body composition, arterial blood pressure, lipid and glucose parameters, diet, and activity) and CVD medication use prior to the initiation of the trial.

Results: The mean age of participants was 37.2 (13.5) years; 40% were female. Participants frequently had cardiovascular risk factors, including obesity (40%), elevated lipid levels (58%), elevated systolic blood pressure/hypertension (60%), elevated glycosylated hemoglobin percent (25%), active smoking (36%), and sedentary lifestyle (49%). Of CVD medications, 82% of those with hypertension were not receiving antihypertensive medications, 99% of those with dyslipidemia were not receiving cholesterol medications, and 97% of those with active smoking were not receiving smoking cessation medication. Among all participants, psychiatric diagnosis was not significantly associated with body mass index and CVD risk.

Conclusions: Despite well-documented CVD morbidity and mortality among people with SMI, CVD risks in individuals with SMI and SGA are common and frequently untreated across psychiatric diagnoses.

Trial Registration: ClinicalTrials.gov identifier: NCT02188121.

J Clin Psychiatry 2025;86(1):24m15392

Author affiliations are listed at the end of this article.

Continue Reading...

Members enjoy unlimited free PDF downloads as part of their subscription! Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.

Subscribe Now

Already a member? Login

Buy PDF for $40

Please sign in or purchase this PDF for $40.

References (45)

Druss BG, Zhao L, Von Esenwein S, et al. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Med Care. 2011;49(6):599–604. PubMed CrossRef
Brown S. Excess mortality of schizophrenia. A meta-analysis. Br J Psychiatry. 1997;171:502–508. PubMed
Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Arch Gen Psychiatry. 2007;64(10):1123–1131. PubMed
Miller BJ, Paschall CB 3rd, Svendsen DP. Mortality and medical comorbidity among patients with serious mental illness. Psychiatr Serv. 2006;57(10):1482–1487. CrossRef
Felker B, Yazel JJ, Short D. Mortality and medical comorbidity among psychiatric patients: a review. Psychiatr Serv. 1996;47(12):1356–1363.
Dembling BP, Chen DT, Vachon L. Life expectancy and causes of death in a population treated for serious mental illness. Psychiatr Serv. 1999;50(8):1036–1042. CrossRef
Henderson DC. Weight gain with atypical antipsychotics: evidence and insights. J Clin Psychiatry. 2007;68(Suppl 12):18–26. PubMed
Leucht S, Cipriani A, Spineli L, et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet. 2013;382(9896):951–962. PubMed CrossRef
Correll CU, Detraux J, De Lepeleire J, et al. Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry. 2015;14(2):119–136. PubMed CrossRef
Pillinger T, McCutcheon RA, Vano L, et al. Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis. Lancet Psychiatry. 2020;7(1):64–77. PubMed CrossRef
Hayes JF, Marston L, Walters K, et al. Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000-2014. Br J Psychiatry. 2017;211(3):175–181. PubMed CrossRef
Nielsen RE, Banner J, Jensen SE. Cardiovascular disease in patients with severe mental illness. Nat Rev Cardiol. 2021;18(2):136–145. CrossRef
Morrato EH, Newcomer JW, Kamat S, et al. Metabolic screening after the American Diabetes Association’s consensus statement on antipsychotic drugs and diabetes. Diabetes Care. 2009;32(6):1037–1042. PubMed CrossRef
Rajkumar AP, Horsdal HT, Wimberley T, et al. Endogenous and antipsychotic related risks for diabetes mellitus in young people with schizophrenia: a Danish population-based cohort study. Am J Psychiatry. 2017;174:686–694. CrossRef
Chouinard VA, Henderson DC, Dalla Man C, et al. Impaired insulin signaling in unaffected siblings and patients with first-episode psychosis. Mol Psychiatry. 2019;24(10):1513–1522. PubMed CrossRef
Pillinger T, D’Ambrosio E, McCutcheon R, et al. Is psychosis a multisystem disorder? A meta-review of central nervous system, immune, cardiometabolic, and endocrine alterations in first-episode psychosis and perspective on potential models. Mol Psychiatry. 2019;24(6):776–794. PubMed CrossRef
Frayne SM, Halanych JH, Miller DR, et al. Disparities in diabetes care: impact of mental illness. Arch Intern Med. 2005;165(22):2631–2638. PubMed
Hardy S, Hinks P, Gray R. Screening for cardiovascular risk in patients with severe mental illness in primary care: a comparison with patients with diabetes. J Ment Health. 2013;22(1):42–50. PubMed CrossRef
Paxton AE, Strycker LA, Toobert DJ, et al. Starting the conversation performance of a brief dietary assessment and intervention tool for health professionals. Am J Prev Med. 2011;40(1):67–71. PubMed CrossRef
Hallal PC, Victora CG. Reliability and validity of the International Physical Activity Questionnaire (IPAQ). Med Sci Sports Exerc. 2004;36(3):556. CrossRef
National Cholesterol Education Program NCEP Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults Adult Treatment Panel III. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143–3421. PubMed
Zheng W, Li XB, Tang YL, et al. Metformin for weight gain and metabolic abnormalities associated with antipsychotic treatment: meta-analysis of randomized placebo-controlled trials. J Clin Psychopharmacol. 2015;35(5):499–509. PubMed CrossRef
Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 suppl 2):S49–S73. PubMed
Berkowitz SA, Meigs JB, DeWalt D, et al. Material need insecurities, control of diabetes mellitus, and use of health care resources: results of the Measuring Economic Insecurity in Diabetes study. JAMA Intern Med. 2015;175(2):257–265. PubMed CrossRef
Voils CI, Maciejewski ML, Hoyle RH, et al. Initial validation of a self-report measure of the extent of and reasons for medication nonadherence. Med Care. 2012;50(12):1013–1019. PubMed CrossRef
Woods SW. Chlorpromazine equivalent doses for the newer atypical antipsychotics. J Clin Psychiatry. 2003;64(6):663–667. PubMed CrossRef
Wong ND, Budoff MJ, Ferdinand K, et al. Atherosclerotic cardiovascular disease risk assessment: an American Society for Preventive Cardiology clinical practice statement. Am J Prev Cardiol. 2022;10:100335. PubMed CrossRef
Hales CM, Carroll MD, Fryar CD, et al. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief; 2020;(360):1–8. PubMed
Center for Disease Control and Prevention. Massachusetts State Nutrition, Physical Activity and Obesity Profile. National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity and Obesity; 2016.
Chouinard VA, Pingali SM, Chouinard G, et al. Factors associated with overweight and obesity in schizophrenia, schizoaffective and bipolar disorders. Psychiatry Res. 2016;237:304–310. PubMed CrossRef
Meyer JM, Nasrallah HA, McEvoy JP, et al. The Clinical Antipsychotic Trials Of Intervention Effectiveness (CATIE) Schizophrenia Trial: clinical comparison of subgroups with and without the metabolic syndrome. Schizophr Res. 2005;80(1):9–18. PubMed CrossRef
Correll CU, Robinson DG, Schooler NR, et al. Cardiometabolic risk in patients with first-episode schizophrenia spectrum disorders: baseline results from the RAISE ETP study. JAMA psychiatry. 2014;71(12):1350–1363. PubMed CrossRef
Shain BN, Committee OA. Collaborative role of the pediatrician in the diagnosis and management of bipolar disorder in adolescents. Pediatrics. 2012;130(6):e1725–e1742. PubMed CrossRef
Corrigan PW, Mittal D, Reaves CM, et al. Mental health stigma and primary health care decisions. Psychiatry Res. 2014;218(1–2):35–38. PubMed CrossRef
Thom S, Poulter N, Field J, et al. Effects of a fixed-dose combination strategy on adherence and risk factors in patients with or at high risk of CVD: the UMPIRE randomized clinical trial. JAMA. 2013;310(9):918–929. PubMed
PILL Collaborative Group; Rodgers A, Patel A, et al. An international randomised placebo-controlled trial of a four-component combination pill (“polypill”) in people with raised cardiovascular risk. PLoS One. 2011;6(5):e19857. PubMed CrossRef
Yusuf S, Islam S, Chow CK, et al. Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low income countries (the PURE Study): a prospective epidemiological survey. Lancet. 2011;378(9798):1231–1243. PubMed CrossRef
Acosta FJ, Hernandez JL, Pereira J, et al. Medication adherence in schizophrenia. World J Psychiatry. 2012;2(5):74–82.
Ferdinand KC, Senatore FF, Clayton-Jeter H, et al. Improving medication adherence in cardiometabolic disease: practical and regulatory implications. J Am Coll Cardiol. 2017;69(4):437–451. PubMed CrossRef
Walburg FS, van Meijel B, Hoekstra T, et al. Effectiveness of a lifestyle intervention for people with a severe mental illness in Dutch outpatient mental health care: a randomized clinical trial. JAMA psychiatry. 2023;80(9):886–894. PubMed CrossRef
Daumit GL, Dickerson FB, Wang NY, et al. A behavioral weight-loss intervention in persons with serious mental illness. N Engl J Med. 2013;368(17):1594–1602. CrossRef
Biddinger KJ, Emdin CA, Haas ME, et al. Association of habitual alcohol intake with risk of cardiovascular disease. JAMA Netw Open. 2022;5(3):e223849. PubMed CrossRef
Burnette EM, Nieto SJ, Grodin EN, et al. Novel agents for the pharmacological treatment of alcohol use disorder. Drugs. 2022;82(3):251–274. PubMed CrossRef
Morrato EH, Nicol GE, Maahs D, et al. Metabolic screening in children receiving antipsychotic drug treatment. Arch Pediatr Adolesc Med. 2010;164(4):344–351. PubMed CrossRef
Galling B, Roldan A, Nielsen RE, et al. Type 2 diabetes mellitus in youth exposed to antipsychotics: a systematic review and meta-analysis. JAMA Psychiatry. 2016;73(3):247–259. PubMed CrossRef