Lipid Profile Monitoring In Veterans Living With Schizophrenia-Related Disorders And Treated With Second-Generation Antipsychotics: Findings From A VA-Based Population

Ried LD. Lipid Profile Monitoring In Veterans Living With Schizophrenia-Related Disorders And Treated With Second-Generation Antipsychotics: Findings From A VA-Based Population. Poster session presented at: American Pharmaceutical Association Annual Meeting; 2007 Mar 17; Atlanta, GA.

Objectives: To (1) describe the proportion of veterans living with schizophrenia-related disorders monitored for dyslipidemia and (2) examine the influences of socio-demographic characteristics, dyslipidemia treatment status, and prior monitoring on the likelihood of being monitored after switching from one second-generation antipsychotic (SGA) to another. Methods: The population was veterans living with schizophrenia-related disorders enrolled in the Veterans Affairs Health Care System switched from one SGA to another SGA between October 1, 2002 and September 30, 2003. The index date was the dispensing date of the first prescription for the subsequent SGA. Eligible veterans were dispensed the first SGA for 90-days or longer before the switch and were dispensed prescriptions for the subsequent SGA for 180-days or longer afterward. c-ldl, c-hdl and triglyceride levels were abstracted from automated records for 6-months prior to the index date and 12-months afterward. Information regarding veterans’ age, gender, race and pre-switch use of lipid-lowering medications was abstracted from automated records. Characteristics predictive of lipid monitoring 12-months after SGA switches were determined using multivariate logistic regression models. Results: The mean age of the 1,826 veterans was 51.6 years (SD = 10.6) and they were predominately male (92%). Nearly 55% of the veterans were White, 25% were African American, 9% were Hispanic, and 11% were another minority or their race was not available. Nearly 39% of the veterans had their lipids monitored during the 6-months before the switch and 59% during the 12-months afterward. Of those monitored, 27% were monitored both before and after the switch. However, 41% did not have any indication of lipid monitoring during the year after the switch and 32% were unmonitored during the entire 18-month study period. Nearly 21% (N = 376) of the veterans were dispensed lipid-lowering medications during the 6-months before the switch. Pre-switch treatment with a lipid lowering medication (odds ratio [OR] = 2.46, p < .001), pre-switch lipid monitoring (OR = 2.30, p < .001) and patient’s age³ 50 (OR = 1.28, p = .02) were significant predictors of lipid monitoring after the SGA switch. Conclusion: Pharmacists and physicians should be aware that switching from one SGA to another warrants closer monitoring because of lipid dysregulation associated with SGAs. After switching SGAs, lipid levels of veterans living with schizophrenia-related disorders were monitored more closely if they were at higher risk of adverse metabolic outcomes according to guidelines.