METABOLIC SYNDROME IN A CORRECTIONS
POPULATION TREATED WITH ANTIPSYCHOTICS
Andrew M. Cislo, PhD
Megan J. Ehret, PharmD, MS, BCPP
Robert L. Trestman, MD, PhD
Kirsten Shea, MBA
www.uchc.edu
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/ATP
III Guidelines
Background
• Community Prevalence of
Metabolic Syndrome: 24-34%
•
•
•
•
•
Physical Activity
Poor Nutrition
Substance Abuse
Smoking
Culture/Diet
Older age
Gender * Race/ethnicity
Overweight
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
Clozapine
Olanzapine
Quetiapine
Risperidone
Paliperidone
Aripiprazole
Lurasidone
Iloperidone
Ziprasidone
Asenapine
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 2010June 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
% Sex
Male
Female
Sample Description (N=X)
% Rx Generation
First Gen Only
Second Gen Only
First to Second
Second to First
% Ever 2nd Gen
Ever 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?
Contact Information
Andrew M. Cislo, PhD
Director of Research and Evaluation
Correctional Managed Health Care
University of Connecticut Health Center
263 Farmington Avenue, ASB Bldg., 3rd floor
Farmington, CT 06030-5386
Phone: 860-282-8575
Email: cislo@uchc.edu
www.uchc.edu