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.

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