Use of medications to reduce cardiovascular risk among individuals with psychotic disorders and Type 2 diabetes

Kreyenbuhl, Julie; Medoff, Deborah R.; Seliger, Stephen L.; Dixon, Lisa B.

doi:10.1016/j.schres.2008.02.004

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Volume 101, Issue 1 , Pages 256-265, April 2008

Use of medications to reduce cardiovascular risk among individuals with psychotic disorders and Type 2 diabetes

Julie Kreyenbuhl
- Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 W. Lombard Street, 5th floor, Baltimore, MD, 21201, United States
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), 10 N. Greene St. (BT/MIRECC), Baltimore, MD, 21201, United States
- Corresponding author. University of Maryland School of Medicine, Department of Psychiatry, Division of Services Research, 737 W. Lombard Street, 5th floor, Baltimore, MD 21201, United States. Tel.: +1 410 605 7466; fax: +1 410 605 7739.
Deborah R. Medoff
- Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 W. Lombard Street, 5th floor, Baltimore, MD, 21201, United States
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), 10 N. Greene St. (BT/MIRECC), Baltimore, MD, 21201, United States
Stephen L. Seliger
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, 22 S. Greene St., N3W143, Baltimore, MD, 21201, United States
Lisa B. Dixon
- Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 W. Lombard Street, 5th floor, Baltimore, MD, 21201, United States
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), 10 N. Greene St. (BT/MIRECC), Baltimore, MD, 21201, United States

Received 6 November 2007; received in revised form 5 February 2008; accepted 7 February 2008. published online 20 March 2008.

Abstract

Objective

Cardiovascular disease (CVD) is the leading cause of death in patients with serious mental illness (SMI) and in patients with Type 2 diabetes. Inadequate pharmacologic care for CVD may partially explain poor health outcomes in individuals with both conditions. We sought to identify patients in this group at greatest risk for suboptimal pharmacologic management.

Methods

Among individuals with Type 2 diabetes and SMI identified from Maryland Medicaid data, we evaluated patient and service utilization factors associated with the prescription of HMG-CoA reductase inhibitors (“statins”) for hyperlipidemia and angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for chronic kidney disease, congestive heart failure, and hypertension.

Results

From 2001 to 2003, the annual prevalence of use of statins and ACE-inhibitors/ARBs ranged from 44 to 59%, with rates increasing each year. Being female, having certain cardiovascular conditions, and having a greater number of outpatient visits for diabetes increased the odds of receiving statins and ACE-inhibitors/ARBs. More frequent contact with the mental health system was associated with a lower likelihood of receipt of both medication classes; having a substance use disorder was associated with reduced use of statins. African-Americans were less likely than Caucasians to receive statins, but more likely to receive prescriptions for ACE-inhibitors/ARBs.

Conclusions

Although the use of cardioprotective medications in individuals with Type 2 diabetes and SMI increased over the study period, a considerable proportion of patients remained inadequately managed despite their considerable cardiac risk. Further study should focus on observed racial variations and strategies to increase the capacity of mental health contacts to improve prescribing of these agents.

Keywords: Diabetes, Serious mental illness, Medicaid database analysis