Management of elevated blood cholesterol in the psychiatric patient: What's new in the guidelines?

Compared with the general adult population, patients with schizophrenia and bipolar disorder have a 1.5 to 2.8 fold increase in mortality rates. This increase in mortality is multifactorial, including both natural causes and suicide. Additionally, antipsychotic medications have been associated with several adverse effects, including weight gain, hyperlipidemia, and the onset of diabetes. These adverse effects can place patients at risk for metabolic syndrome and atherosclerotic cardiovascular disease (ASCVD). Regular monitoring and treatment of risk factors for ASCVD, including hyperlipidemia, should be provided in clinical practice. The American College of Cardiology and the American Heart Association recently published updated recommendations for the management of cholesterol to reduce ASCVD. These national guidelines, based on a large body of clinical trials, describe 4 specific patient populations at high risk for ASCVD that should be considered candidates for therapeutic lifestyle changes and pharmacologic treatment. Statin therapy should be considered a first-line treatment option for these patients due to a favorable benefit versus risk profile. Of note, the new guidelines do not recommend a specific LDL target for patients. Instead, either a moderate or high-intensity statin should be recommended based on the patients' comorbidities. Health care providers can have a significant impact on the cardiovascular health of psychiatric patients by appropriately monitoring and treating hyperlipidemia.